Orange County NC Website
DocuSign Envelope ID:8541D12F-AB76-4A42-BOEE-OF54104EE073 A 11ac ment <br /> DATE(MM/DD/YYYY) <br /> A�" CERTIFICATE OF LIABILITY INSURANCE <br /> 01/08/2021 <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 <br /> NAME: <br /> RSC Insurance Brokerage,Inc. ,C No Ext: (212)596-3400 ac,No): (212)596-3460 <br /> 160 Federal St. E-MAIL <br /> ADDRESS: <br /> 4th Floor INSURER(S)AFFORDING COVERAGE NAIC# <br /> Boston MA 02110 INSURERA: Hartford Fire Insurance Company 19682 <br /> INSURED INSURER B: Trumbull Insurance Company 27120 <br /> NWN Corporation INSURERC: Hartford Casualty Insurance Company 29424 <br /> 271 Waverly Oaks Road,Ste.100 INSURER D: Twin City Fire Insurance Company 29459 <br /> INSURER E: <br /> Waltham MA 02452 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: CL20121487041 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 INSURANCEADDLSUBR POLICY EFF POLICY EXP <br /> LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> CLAIMS-MADE X OCCUR PRIM SES Ea :Nru ence $ 300,000 <br /> MED EXP(Any one person) $ 10,000 <br /> A 08UUNBA6761 12/15/2020 12/15/2021 PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN-LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> X JECT LOC PRODUCTS-COMP/OPAGG $POLICY ❑ PRO 2,000,000 <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 <br /> Ea accident <br /> X ANYAUTO BODILY INJURY(Per person) $ <br /> B OWNED SCHEDULED 08UENBA7384 12/15/2020 12/15/2021 BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 <br /> C EXCESS LAB CLAIMS-MADE 08XHUBA6901 12/15/2020 12/15/2021 AGGREGATE $ 10,000,000 <br /> DED I X1 RETENTION $ 10,000 $ <br /> WORKERS COMPENSATION X PER <br /> STATUTE ERH <br /> AND EMPLOYERS'LIABILITY Y/N 1,000,000 <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ <br /> D OFFICER/MEMBER EXCLUDED? NIA 08WEAE2JVW 12/15/2020 12/15/2021 <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 /> Tech E&O <br /> A 08TE034486319 12/15/2020 12/15/2021 Limit $10,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Evidence of Insurance <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 /> Orange County Office Building ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 131 West Margaret Lane <br /> AUTHORIZED REPRESENTATIVE <br /> Hillsborough NC 27278 fYCr f <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />