Orange County NC Website
DocuSign Envelope ID:CAFE7F47-667A-4DCB-8308-4812EB80F267 <br /> DATE(MM/DD/YYYY) <br /> A�" CERTIFICATE OF LIABILITY INSURANCE <br /> 12/09/2021 <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 April Ruiz <br /> NAME: <br /> RSC Insurance Brokerage,Inc. PHONE FAX <br /> A/C No Ext: A/C,No): <br /> 1350 Avenue of the Americas E-MAIL aruiz@krautergroup.com <br /> ADDRESS: <br /> 18th Floor INSURER(S)AFFORDING COVERAGE NAIC# <br /> New York NY 10019 INSURERA: Hartford Fire Ins Co 19682 <br /> INSURED INSURER B: Hartford Casualty Insurance Co 29424 <br /> Carousel Industries of North America,LLC INSURER C: Hartford Ins Co of the Midwest 37478 <br /> 659 South County Trail INSURER D: XL Select Insurance Company 19607 <br /> INSURER E: <br /> Exeter RI 02822 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: CL2192135086 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 PREM SES Ea oNcE ante $ 300,000 <br /> MED EXP(Any one person) $ 10,000 <br /> A 08 UUN BB6213 05/07/2021 05/07/2022 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 08UENBB6262 05/07/2021 05/07/2022 BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> X Comp$1,000 Hx Coll$1,000 $ <br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 13,000,000 <br /> B EXCESS LAB CLAIMS-MADE 08 XHU BB5564 05/07/2021 05/07/2022 AGGREGATE $ 13,000,000 <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 /> C OFFICER/MEMBER EXCLUDED? NIA 08WEAK5SHK 05/07/2021 05/07/2022 <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/CYBER <br /> D MTP904316700 05/07/2021 05/07/2022 Limit: $5,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> This certificate is issued as evidence of insurance coverage only. <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 />