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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 />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 />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 />$
<br />CERTIFICATE HOLDER
<br />© 1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03)
<br />AUTHORIZED REPRESENTATIVE
<br />CANCELLATION
<br />DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE
<br />OTHER:
<br />LOCJECT
<br />PRO-POLICY
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />OCCURCLAIMS-MADE
<br />COMMERCIAL GENERAL LIABILITY
<br />PREMISES (Ea occurrence)$
<br />DAMAGE TO RENTED
<br />EACH OCCURRENCE $
<br />MED EXP (Any one person)$
<br />PERSONAL & ADV INJURY $
<br />GENERAL AGGREGATE $
<br />PRODUCTS - COMP/OP AGG $
<br />$RETENTIONDED
<br />CLAIMS-MADE
<br />OCCUR
<br />AGGREGATE $
<br />EACH OCCURRENCE $UMBRELLA LIAB
<br />EXCESS LIAB
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />INSR
<br />LTR TYPE OF INSURANCE POLICY NUMBER
<br />POLICY EFF
<br />(MM/DD/YYYY)
<br />POLICY EXP
<br />(MM/DD/YYYY)LIMITS
<br />PER
<br />STATUTE
<br />OTH-
<br />ER
<br />E.L. EACH ACCIDENT
<br />E.L. DISEASE - EA EMPLOYEE
<br />E.L. DISEASE - POLICY LIMIT
<br />$
<br />$
<br />$
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />(Mandatory in NH)
<br />OFFICER/MEMBER EXCLUDED?
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />AUTOMOBILE LIABILITY
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />HIRED NON-OWNED
<br />AUTOS ONLY AUTOS
<br />AUTOS ONLY AUTOS ONLY
<br />COMBINED SINGLE LIMIT
<br />BODILY INJURY (Per person)
<br />BODILY INJURY (Per accident)
<br />PROPERTY DAMAGE $
<br />$
<br />$
<br />$
<br />$
<br />INSD
<br />ADDL
<br />WVD
<br />SUBR
<br />N / A
<br />$
<br />(Ea accident)
<br />(Per accident)
<br />The ACORD name and logo are registered marks of ACORD
<br />COVERAGES CERTIFICATE NUMBER:REVISION NUMBER:
<br />INSURED
<br />PHONE
<br />(A/C, No, Ext):
<br />PRODUCER
<br />ADDRESS:
<br />E-MAIL
<br />FAX
<br />(A/C, No):
<br />CONTACT
<br />NAME:
<br />NAIC #
<br />INSURER A :
<br />INSURER B :
<br />INSURER C :
<br />INSURER D :
<br />INSURER E :
<br />INSURER F :
<br />INSURER(S) AFFORDING COVERAGE
<br />$
<br />$
<br />$
<br />$
<br />$
<br />K94MKA9F
<br />10/01/2020
<br />Orange County
<br />200 South Cameron Street, PO Box 8181
<br />Hillsborough, NC 27278
<br />1,000,000
<br />1,000,000
<br />713-877-8975 713-877-8974
<br />Continental Casualty Company
<br />D
<br />American Casualty Company of Reading, Pennsylvania
<br />1,000,000
<br />1,000,000
<br />20494
<br />10/01/202010/01/2019
<br />10/01/202010/01/2019
<br />1,000,000
<br />1,000,000
<br />3,000,000
<br />20443
<br />A
<br />Transportation Insurance Company
<br />6075838847
<br />5094621644
<br />A
<br />B
<br />C
<br />3,000,000
<br />1,000,000
<br />N
<br />MCGRIFF, SEIBELS & WILLIAMS OF TEXAS, INC.
<br />10100 Katy Freeway, #400
<br />Houston, TX 77043
<br />Delerrok Inc.
<br />221 Main Street STE 200
<br />Vista, CA 92084
<br />06/26/2020
<br />10/01/2019
<br />WC6072902292- AZ, OR & MA
<br />WC6072902258 - CA
<br />WC6072902177 - AOS
<br />10/01/2019
<br />1,000,000
<br />10/01/2020
<br />RE: OCPT
<br />Orange County, its officers, official agents and employees are included as Additional Insured as respects to General Liability and Umbrella Liability. A Waiver of Subrogation
<br />is provided as respects to Umbrella Liability and Workers' Compensation. In the event of cancellation by the insurance companies, the policies have been endorsed to
<br />provide (30) days Notice of Cancellation (except for 10 days for non-payment of premium) to the certificate holder shown below. All where required by written contract
<br />subject to policy terms, conditions and exclusions.
<br />1,000,000
<br />6075780061
<br />20427
<br />Continental Insurance Company
<br />X
<br />XX
<br />X
<br />X
<br />X
<br />X
<br />X
<br />X
<br />X
<br />XX
<br />X
<br />Page 1 of 1
<br />DocuSign Envelope ID: 000FC59A-58C3-40A5-B7DA-3677E8179B51
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