|
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />INSURER(S) AFFORDING COVERAGE
<br />INSURER F :
<br />INSURER E :
<br />INSURER D :
<br />INSURER C :
<br />INSURER B :
<br />INSURER A :
<br />NAIC #
<br />NAME:CONTACT
<br />(A/C, No):FAX
<br />E-MAILADDRESS:
<br />PRODUCER
<br />(A/C, No, Ext):PHONE
<br />INSURED
<br />REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES
<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 />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 />OTHER:
<br />(Per accident)
<br />(Ea accident)
<br />$
<br />$
<br />N / A
<br />SUBR
<br />WVD
<br />ADDL
<br />INSD
<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 />$
<br />$
<br />$
<br />$PROPERTY DAMAGE
<br />BODILY INJURY (Per accident)
<br />BODILY INJURY (Per person)
<br />COMBINED SINGLE LIMIT
<br />AUTOS ONLY
<br />AUTOSAUTOS ONLY NON-OWNED
<br />SCHEDULEDOWNED
<br />ANY AUTO
<br />AUTOMOBILE LIABILITY
<br />Y / N
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />DESCRIPTION OF OPERATIONS below
<br />If yes, describe under
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />$
<br />$
<br />$
<br />E.L. DISEASE - POLICY LIMIT
<br />E.L. DISEASE - EA EMPLOYEE
<br />E.L. EACH ACCIDENT
<br />EROTH-STATUTEPER
<br />LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />EXCESS LIAB
<br />UMBRELLA LIAB $EACH OCCURRENCE
<br />$AGGREGATE
<br />$
<br />OCCUR
<br />CLAIMS-MADE
<br />DED RETENTION $
<br />$PRODUCTS - COMP/OP AGG
<br />$GENERAL AGGREGATE
<br />$PERSONAL & ADV INJURY
<br />$MED EXP (Any one person)
<br />$EACH OCCURRENCE
<br />DAMAGE TO RENTED $PREMISES (Ea occurrence)
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS-MADE OCCUR
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY PRO-JECT LOC
<br />CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
<br />CANCELLATION
<br />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2016/03)
<br />© 1988-2016 ACORD CORPORATION. All rights reserved.
<br />CERTIFICATE HOLDER
<br />The ACORD name and logo are registered marks of ACORD
<br />HIRED
<br />AUTOS ONLY
<br />2,000,000
<br />05/01/2022
<br />Manashi Mukherjee
<br />HWXJ-UB-472M4779-21 (XWC OH)
<br />CHI-009853058-01
<br />2,000,000
<br />UB-6R80648A-21-NC-R (MA & WI)
<br />X
<br />N/A
<br />Annual Aggregate
<br />of Marsh USA Inc.
<br /> Attn: Healthcare.AccountsCSS@marsh.com Fax: 212-948-1307
<br />N
<br />05/01/2020
<br />X05/01/2021
<br />1
<br />05/01/2020
<br />A
<br />05/01/2022
<br />eis@uhg.com
<br />Managed Care Professional Liab
<br />C
<br />4,000,000
<br />MWZY315405
<br />2,000,000
<br />(SIR $2M - XWC OH)
<br />25674
<br />N/A
<br />2,000,000
<br />X
<br />A
<br />X
<br />05/28/2021
<br />10,000,000
<br />10,000,000
<br />05/01/2021
<br />RE: STATE OF NORTH CAROLINA VACCINATION AGREEMENT / ADDITIONAL INSURED: ORANGE COUNTY GOVERMENT
<br /> THE GENERAL LIABILITY POLICY INCLUDES A BLANKET ADDITIONAL INSURED ENDORSEMENT FOR PERSONS OR ORGANIZATIONS WHERE THE NAMED INSURED IS OBLIGATED TO PROVIDE
<br />X
<br />05/01/2021
<br /> ORANGE COUNTY, NC, PO BOX 8181
<br /> HILLSBOROUGH, NC 27281-8181
<br /> ORANGE COUNTY GOVERNMENT
<br />SUCH STATUS BY WRITTEN CONTRACT OR AGREEMENT, ONLY TO THE MINIMUM EXTENT REQUIRED AND SUBJECT TO POLICY TERMS AND CONDITIONS.
<br />C
<br />Travelers Property Casualty Company of America
<br />CN101631729-ALL-GAWUP-21-22
<br />Each Claim
<br />2,500
<br />05/01/2022
<br />5,000,000
<br />05/01/2022
<br />Retro Date: 1/1/77
<br />C
<br />MWTB315404
<br />4,000,000
<br />24147
<br />1,000,000
<br />2,000,000
<br />05/01/2022
<br />UB-6R864629-21-NC-T (AOS)
<br /> 333 South 7th Street, Suite 1400
<br /> Marsh USA Inc.
<br /> Minneapolis, MN 55402-2400
<br /> 328 FRONT STREET SOUTH
<br /> LOGISTICS HEALTH, INC.
<br /> LA CROSSE, WI 54601
<br />MWZZ315406
<br /> ATTN: RISK MANAGER
<br />05/01/2020
<br />Enterprise Risk Financing & Insurance
<br />05/01/2022
<br />A
<br />952 936-1172
<br />Old Republic Insurance Company
<br />DocuSign Envelope ID: 3972E6CB-2728-4F85-9405-C3827B138ABF
|