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DocuSign Envelope ID:9873F8FB-347E-4F54-96C2-C188C918673F <br /> ALSCINC-01 JANDRUS <br /> '4�aRo CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) <br /> 9/4/2019 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. <br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on <br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT Jake Andrus <br /> NAME: <br /> HUB International Insurance Services Inc. PHONE, <br /> H NE,Ext: 801 947-4104 FAX <br /> 75 W.Towne Ridge Pkwy ) (A/C,No): <br /> Tower 2,Suite 400 E-MAIL Jake.Andrus@hubinternational.com <br /> Sandy,UT 84070 <br /> INSURERS AFFORDING COVERAGE NAIC# <br /> INSURER A:ACE American Insurance Company 22667 <br /> INSURED INSURER B:Indemnity Insurance Company of NA 43575 <br /> AISCo Inc. INSURER C: <br /> 3301 Hillsborough Street INSURERD: <br /> Raleigh,NC 27607 <br /> INSURER E <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS <br /> LTR IN SD WVD MM DD MM DD <br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 <br /> CLAIMS-MADE OCCUR HDOG27629416 11/1/2018 11/1/2019 DAMAGE TO RENTED 2,000,000 <br /> PREMISES Ea occurrence $ <br /> MED EXP(Any one person $ 0 <br /> PERSONAL&ADV INJURY $ 2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000 <br /> X POLICY PECOT- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> OTHER: <br /> A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 5,000,000 <br /> Ea accident $ <br /> X ANY AUTO ISAH08868906 11/1/2018 11/1/2019 BODILY INJURY Perperson) $ <br /> OWNED SCHEDULED <br /> AUTOS ONLY AUTOS BODILY INJURY Per accident $ <br /> X HIRED X NON-OWNED PerOac R DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ <br /> B WORKERS COMPENSATION X PER OTH- <br /> AND EMPLOYERS'LIABILITY STATUTE ER <br /> WLRC48133629 11/1/2018 11I1I2019 1,000,000 <br /> ANY PROPRIETOR P /EXECUTIVE N I E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 <br /> If yes,describe under 1,000,000 <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Orange Count Transportation Services THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> g Y p ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 600 HWY 86 N <br /> Hillsborough, NC 27278 <br /> AUTHORIZED REPRESENTATIVE <br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />