Orange County NC Website
DocuSign Envelope ID:352138017-1`115-48D8-A28D-710EODC69AO9 <br /> 701� <br /> E(MM/DD/YYYY) <br /> A�" CERTIFICATE OF LIABILITY INSURANCE <br /> 127/2022 <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 /> MARSH USA,INC. NAME,PHONE FAX <br /> 445 SOUTH STREET A/C,No,Ext: A/C No), <br /> MORRISTOWN,NJ 07960-6454 E-MAIL <br /> ADDRESS: <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> CN102147003-RAM--22/23 228 Rentas NOC60 INSURERA: HDI Global Insurance Company 41343 <br /> INSURED INSURER B: Travelers Property Casualty Co.of America 25674 <br /> SIEMENS INDUSTRY,INC. <br /> 1000 DEERFIELD PARKWAY INSURER C: The Travelers Indemnity Company 25658 <br /> BUFFALO GROVE,IL 60089-4513 INSURER D: <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: NYC-009196547-30 REVISION NUMBER: 2 <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 SUBR POLICY EFF POLICY EXP LIMITS <br /> LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DDIYYYY <br /> A X COMMERCIAL GENERAL LIABILITY GLD1110114 10/01/2022 10/01/2023 EACH OCCURRENCE $ 1,000,000 <br /> DAMAGE TO CLAIMS-MADE X� OCCUR PREMISES <br /> ('a <br /> a RENTED <br /> ) $ 1,000,000 <br /> MED EXP(Any one person) $ 100,000 <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10,000,000 <br /> X POLICY❑ PRO- <br /> POLICY ❑ LOC PRODUCTS-COMP/OP AGG $ INCL <br /> OTHER: $ <br /> B AUTOMOBILE LIABILITY TC2J-CAP-7440L34A-TIL-22 10/01/2022 10/01/2023 COMBINED SINGLE LIMIT $ 2,000,000 <br /> Ea accident <br /> X ANY AUTO BODILY INJURY(Per person) $ N/A <br /> X OWNED SCHEDULED BODILY INJURY(Per accident) $ N/A <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE <br /> X AUTOS ONLY X AUTOS ONLY Per accident) <br /> ccident $ N/A <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> B WORKERS COMPENSATION UB-8P83929A-22-51-K(AOS) 10/01/2022 10/01/2023 X PER oTH- <br /> AND EMPLOYERS'LIABILITY STATUTE ER <br /> C ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N N/A <br /> UB-8P79233A-22-51-R(AZ,MA,WI) 10/01/2022 10101/2023 E.L.EACH ACCIDENT $ 1,000,000 <br /> B OFFICER/MEMBER EXCLUDED? ❑N <br /> (Mandatory in NH) TWXJUB-7440L338-TIL-22(OH) 10/01/2022 10/01/2023 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 <br /> If yes,describe under """""'$500K LIMIT/$500K SIR"""""' 1,000,000 <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> RE:JOB NO.N/A <br /> SEE ATTACHED <br /> CERTIFICATE HOLDER CANCELLATION <br /> COUNTY OF ORANGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> ASSET MANAGEMENT SERVICES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> 600 NC HIGHWAY 86 N ACCORDANCE WITH THE POLICY PROVISIONS. <br /> HILLSBOROUGH,NC 27278 <br /> AUTHORIZED REPRESENTATIVE <br /> of Marsh USA Inc. <br /> ©1988-2016 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />