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DocuSign Envelope ID:4FE28997-8839-4B4D-BA87-lA027F8E5CED
<br /> ,d►��vim® CERTIFICATE OF LIABILITY INSURANCE DATE/26/20 9(MMIDDNYYY)
<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 NAME:CONTACT Lori Staples _
<br /> Arthur J. Gallagher Risk Management Services, Inc. PHONE 336-217-5767 FAX
<br /> 4700 Homewood Court, Suite 260 1AIC,No):336-275-1776
<br /> Raleigh NC 27609-5732 AODRRe • Lori Sta les a' .corn
<br /> INSURERS)AFFORDING COVERAGE NAIC 8
<br /> INSURER A:Safety National Casualty Cor oration 15105
<br /> INSURED COUNOFD-01 INSURER B:Travelers Indemnity Company 25658
<br /> County of Durham
<br /> Durham Co Courthouse INSURERC:
<br /> 3rd Floor#200 INSURER D:
<br /> Durham NC 27701 INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:982070630 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 /> INSN�i iADDL SUBR POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/Yl'YY LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY GLE4058675 8/1/2019 7/1/2020 EACH OCCURRENCE $2,000,000
<br /> CLAIMS-MADE OCCUR DAMAGE TO RENTED
<br /> PREMISES(Ea occurrence) $500,000
<br /> _ MED EXP(Any one person) $
<br /> PERSONAL&ADV INJURY $2,000,000
<br /> GE_N'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000
<br /> X POLICY D JECT LOC .PRODUCTS-COMP/OPAGG I$4,000,000
<br /> OTHER: Retention $1,000,000
<br /> A AUTOMOBILE LIABILITY CAE4058676 8/1/2019 7/1/2020 COMBINED SINGLE LIMIT $2 000,000
<br /> Ea accident)
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED —7 SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS _
<br /> HIRED NON-OWNED PROPERTYDAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> Retention $1,000.000
<br /> A UMBRELLA LIAB X OCCUR XPE4058677 8/1/2019 7/1/2020 EACH OCCURRENCE $8,000,000
<br /> X EXCESS LIAB CLAIMS-MADE AGGREGATE $8,000.000
<br /> DED RETENTION$ $
<br /> A WORKERS COMPENSATION SP4058706 7/1/2019 711/202D X I PER OTH-
<br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $2,000,000
<br /> OFFICERIM(Mandatory In ER EXCLUDED? N/A E.L.DISEASE-EA EMPLOYEE $2,000,000
<br /> (Mandatory In NH)
<br /> If yes,describe under - -
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$2,000,000
<br /> B Property KTKCMB2A02033919 7/1/2019 7/1/2020 Prop Blanket Limit $350,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required)
<br /> Excess Liability-Self Insured Retention:$1,000,000
<br /> Excess Workers'Compensation-Self Insured Retention:$600,000
<br /> County of Durham Self-Insured Retention:$1,000,000 any one occurrence(the County of Durham is Self-Insured for all losses up to and including this retention
<br /> amount of$1,000,000).
<br /> Excess Liability-This policy includes the following endorsement:North Carolina-Governmental Immunity Endorsement.
<br /> Additional Insured endorsements for Certificate Holders are not included and not relevant to this policy due to the County of Durham's self-insured retention and
<br /> See Attached...
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> County of Durham ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 200 E Main Street
<br /> Durham NC 27701 AUTHORI DREPRESENTATIVE
<br /> USA ����
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
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