2020-190-E AMS - Sasser Child Support Services window

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DocuSign Envelope ID: B2019758-3B85-4429-A677-0329018A3E54 SASSCOM-01 DBAKER CERTIFICATE OF LIABILITY INSURANCE DAT2 DrrYYY, 2/3123raa2a THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or he endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in Ileu of such endorsements. PRODUCER License#1000009384 CONTACT Hub International Carolinas NAMF PHONE Fax PO Box 939 Arc,Ne,Et):(336)228r0541 AIC,Nn,(866)590-4281 Burlington,NO 27216 E-MAIL INSURERS AFFORDING COVERAGE NA1C# INSURER A:Selective Insurance Company of America 12572 INSURED INSURER B:Accident Fund General Insurance Comm 12304 Sasser Companies Inc INSURER C: P 0 Box 10 1NSURERD: Whitsett,NO 27377 `— INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTRA X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS MADE OCCUR S 2253759 2/112020 2r1r2021 FQW ES f.cocEO urrenreL $ 500,000 MED EXP one son 15,000 PERSONAL&ADV INJURY $ 1'000,im GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 3,000,000 POLICY Eljpa LOC PRODUCTS-COMPIOP AGG $ 3,000,000 OTHER: A AUTOMOBILE LIABILITY CQMSINBO SINGLE LIMIT $ 11000,000 x ANY AUTO S 2253759 211/2020 2/112021 BODILY INJURY tPerperson) OWNED SCHEDULED AUTOS ONLY AUTOS EEpp SOD ILY INJURY Peracciden[ $ S ONLY A a ONLY P OP�,-ERJYDAMAGEE A X UMBRELLA LIAB JC OCCUR EACH OCCURRENCE $ 10,000,000 EXCESS LIAR CLAIMS-MADE S 2253759 21112020 2/1/2021 AGGREGATE $ 10,000,000 DED I I RETENTION$ B WORKERS COMPENSATION X PER; 07H- AND EMPLOYERS'L Y r N WCV6139124 2/1/2020 2/112021 IABILITY 11000,000 ANY PROPRIETORIPARTNERIEXECUTIVE E.L EACH ACCIDENT $ %"CER1MEMA7f EXCLUDED? N r A 1,000 000 { andataryIn } E.L.DISEASE-EA EMPLOYEE _, If yes,describe under 1,000,000 ❑ESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT 3 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached fr more space Is requ Ire d) RE: Orange County Emergency Services Building 510 Meadowlands Drive Hillsborough,NC Orange County is an additional insured under the General Liability for work performed by the named Insured for such additional insured,If required by contract signed by an authorized representative of the named insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange Count THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g y ACCORDANCE WITH THE POLICY PROVISIONS. 200 South Cameron St Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) 01988-2015 ACORD CORPORATION. All rights reserved. Tile ACORD name and logo are registered marks of ACORD