Orange County NC Website
DocuSign Envelope ID: D3623623-BE3A-4E89-A890-737C8ECOOB32 <br /> � l EIGRO <br /> ,a►coRo® CERTIFICATE OF LIABILITY INSURANCE DATE(MNI/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 Keisha Brooks <br /> Commercial Lines—800-868-8834 NAME: <br /> air-, o Ext: 704-901-8674 FAX Ne: 610-537-1902 <br /> US(Insurance Services LLC ADDRtEss: keisha.brooks@usi.com <br /> 6100 Fairview Road <br /> ECOI <br /> NSURER(S)AFFORDING COVERAGEE EE�� <br /> Charlotte,NC 28210 EINSURERA: ny Insurance Company INSUREDINsuRER 8: Hartford Fire Insurance Company <br /> The El Group, Inc. INSURERc: Hartford Underwriters Insurance Company 30104 <br /> 2101 Gateway Centre BLVD STE 200 <br /> INSURER D: <br /> INSURER E: <br /> Morrisville NC 27560 <br /> INSURER F <br /> COVERAGES CERTIFICATE NUMBER: 14510100 REVISION NUMBER: See below <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 ADDL SUER POLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDIYYYY) (MMIDONYYYI LIMITS <br /> X COMMERCIAL GENERAL LIABILITY <br /> A PACE302644 09/30/18 09/30/19 EACH OCCURRENCE 5 1,000,000 <br /> CLAIMS-MADE OCCUR 'ATOPREMISES Ea occurrence $ 300,000 <br /> MED EXP(Any one person) S 25,000 <br /> PERSONAL&ADV INJURY S 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> POLICY PEA I LOC <br /> PRODUCTS-COMP/OP AGG S 2,000,000 <br /> OTHER: <br /> 5 <br /> B AUTOMOBILE LIABILITY 22UUNBI0702 06/20/19 06/20/20 COMBINED SINGLE LIMIT $ <br /> Ea accident 1,000,000 <br /> X ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED <br /> AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ <br /> HIRED X NON-OWNED <br /> AUTOS ONLY AUTOS ONLY Per acciden PROPERTY DAMAGE $ <br /> t <br /> X <br /> 5 <br /> A UMBRELLALIAB x OCCUR EXC300995 09/30/18 09/30/19 EACH OCCURRENCE S 5,000,000 <br /> X EXCESS LIAB CLAIMS-MADE <br /> AGGREGATE $ 5,000,000 <br /> DED RETENTION$ $ <br /> C WORKERS COMPENSATION H <br /> 22WEAD4JST 06/20/19 06/20J20 X AND EMPLOYERS'LIABILITY YIN STATUTE ER <br /> ANYPROPRIETORIPARTNER/EXECUTIVE 1,000,000 <br /> OFFICER/MEMBEREXCLUDED? C NIA E.L.EACH ACCIDENT $ <br /> Mandatory to NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 <br /> I <br /> (t yes,describe uner <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 <br /> DESCRIPTION OF OPERATIONS(LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> Orange County Housing&Community Development SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Dept.300 West Tryon Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Hillsborough, NC 27278 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE JJ�� <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD @ 1988-2015 ACORD CORPORATION. All rights reserved. <br />