2023-003-E-Health Dept-Circulation-Transportation services

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DocuSign Envelope ID:9341895D-616B-4A49-BE66-F415107E2F3B DATE(MM/DD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 1 210 8/2 0 2 2 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT MARSH USA,INC. NAME,PHONE FAX TWO ALLIANCE CENTER A/C No Ext: A/C No), 3560 LENOX ROAD,SUITE 2400 E-MAIL ATLANTA,GA 30326 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# CN102926104--GAWUP-21-23 INSURERA: Illinois Union Insurance Co 27960 INSURED INSURER B: ACE American Insurance Company 22667 Circulation,Inc. 1275 Peachtree Street,NE INSURER C: Scottsdale Insurance Company 41297 6th Floor INSURER D: Indemnity Ins Co Of North America 43575 Atlanta,GA 30309 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-005514101-00 REVISION NUMBER: o THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DDIYYYY A X COMMERCIAL GENERAL LIABILITY X MLP G71128192 005 05/15/2022 05/15/2023 EACH OCCURRENCE $ 1,000,000 DAMAGE CLAIMS-MADE X� OCCUR PREM SES�RE a oNcur ence $ 50,000 MED EXP(Any one person) $ PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY❑ PRO- JECT ❑ LOC PRODUCTS-COMP/OPAGG $ 1,000,000 OTHER: $ B AUTOMOBILE LIABILITY X ISA H25564832 05/15/2022 05/15/2023 COEaMBINED accident SINGLE LIMIT $ 2,000,000 X ANY AUTO BODILY INJURY(Per person) $ X OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident A UMBRELLA LIAB X OCCUR X XFL G27171060 010 05/15/2022 05/15/2023 EACH OCCURRENCE $ 10,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000 DED RETENTION$ $ D WORKERS COMPENSATION WLR C68925885(AOS) 05/15/2022 05/15/2023 X STATUTE OERH AND EMPLOYERS'LIABILITY B ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N WLR C68925927(CA,MA) 05/15/2022 05115/2023 E.L.EACH ACCIDENT $ 2,000,000 OFFICER/MEMBER EXCLUDED? � N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 2,000,000 If yes,describe under 2,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Excess Liability HPS0000375 05/15/2022 05/11/2023 Limit 10M XS$10M DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION Orange County Health Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 300 W Tryon Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Hillsborough,NC 27278 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. 's ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD