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DocuSign Envelope ID:D278501D-795E-42B1-AAD3-FC23FD5B9A60
<br /> ao DATE IMMIDDIYYYY)
<br /> ACC]R" CERTIFICATE OF LIABILITY INSURANCE 0 312 81201 9
<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, EXTENT] OR ALTER THE; COVERAGE AFFORDED BY THE POLICIES
<br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING ENSURER(S), AUTHORIZED
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE MOLDER.
<br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.
<br /> If SUBROGATION E5 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
<br /> MARSH USA,INC. NAME:
<br /> PHONE FAX
<br /> 20 CHURCH STREET,8TH FLOOR (A/C No),
<br /> HARTFORD,CT 06103 E-MA IL
<br /> INSURERISIAFFORDINGCOVERAGR NAIC9
<br /> 102428280-Otis-GAWX-19-20 INSURER A:Hartford Fire Insurance Corn 19682
<br /> INSURED OTlS ELEVATOR COMPANY INSURER B:Hartford Underwriters Insurance Company 30104
<br /> ONE FARM SPRINGS ROAD INSURER C:National Union Fire ins Cc Pittsburgh PA 19445
<br /> FARMINGTON,CT OW32 INSURER D:American Horne Assu ranoe Company 19380
<br /> INSURER E:New Hare Shire Ins Co 23841
<br /> INSURER F:Al Insurance Co 19399
<br /> COVERAGES CERTIFICATE NUMBER: NYC-010502694.01 REVISION NUMBER- 0
<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 S BR PDLICY NUMBER �LDICRY EFF MIIDDlYYYY LIMITS
<br /> LTR
<br /> A X COMMERCIAL GENERALLIABILITY 02CSET10004 04/0112019 WOV2020 EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE 7 OCCUR "$2,000,000 General Aggregate" DAMAGE TO REN 107-
<br /> PREMISES Ea occurrence $ 300,000
<br /> "Per Project 1 Location" MED EX?(Any oneperson) $ 10,000
<br /> "$10,000,000 General Aggregate' PERSONAL BADV INJURY $ 1,000,000
<br /> GENT AGGREGATE LIMIT APPLIES PER: 'Per Policy' GENERAL AGGREGATE $ 2,0WX00
<br /> POLICY PRO-1ECT LOC PRODUCTS-COMP/OP AGG $ 2,000.000
<br /> OTHER' $
<br /> A AUTOMOBILELIABILITY 02CSFT10000(ADS) 04MI2019 0410112020 COM6INE0 SINGLE LIMIT $ 1,000,000
<br /> Ea accident
<br /> B X ANY AUTO 02SET10019(HI) 04/0112019 04101/2020 BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> X HIRED X NON-OWNED PROPERTYDAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per acciidenl
<br /> $
<br /> X UMBRELLA LIAB X OCCUR 02HUTICO21 04/0112019 04/01/2020 EACH OCCURRENCE $ 10,000,000
<br /> EXCESS LIAR CLAIMS-MADE AGGREGATE $ 10,000,000
<br /> DIED I I RETENTION$ $
<br /> C WORKERS COMPENSATION CT-0815565605[SIR$2.5M] 0410112019 0410112020 X I PER OTEf-
<br /> AND EMPLOYERS'LIABILITY STAT TE ER
<br /> 0Y 1 N (E)FL-01271 7193;MULTI-012717191 0410112019 04101/2020 1 000 000
<br /> ANYPROPRIETORIPARTNERIExECUTIVE E.L.EACH ACCIDENT $
<br /> E OFFICERIMEMBEREXCLUDED? NIA MULTI.012717194;MULTI.012717190 04101/2019 04/01/2020 1,000,000
<br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $
<br /> E If yes,describe under (F)NY-012717197(D)CA-012717192 04101/2019 04/01/2020 E.L.DISEASE-POLICY LIMIT $ 1,000,000
<br /> DESCRIPTION OF OPERATIONS below
<br /> DESCRIPTION OF OPERATION51 LOCATIONSI VEHICLES(AC 0RD 101,Add itlonal Remarks Schedule,may he attached if more space Is required)
<br /> This cerhfirate only applies to 100 E KING ST,3W W TRYON ST-HUMAN SVC,106 E MARGARET LAN E,125 COURT ST,COUNTY JAIL,510 MEADOWLANDS DRIVE,106 E:MARGARET LANE,2551
<br /> HOMESTEAD ROAD,COURT AND KING STREETS,301 W TRYON STREET,200 S CAMERON STREET,1 D6 NASH&KOLLOCK ST
<br /> TRD08016A.
<br /> TR008016Z
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> Orange County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> PO Box 8181 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Hlllshorough,NC 27278 ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> AUTHDRIZED REPRESENTATIVE
<br /> of Marsh USA Inc.
<br /> Manashi Mukherjee
<br /> ©1988-2016 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
<br />
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