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DocuSign Envelope ID:A3DOFC59-07OD-48DB-AC4E-405DD26F2774
<br /> A�" CERTIFICATE OF LIABILITY INSURANCE DATE
<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:
<br /> PHONE FAX
<br /> Gateway Plaza A/C No Ext: A/C No),
<br /> 800 East Canal St.Suite 900 E-MAIL
<br /> Richmond,VA 23219 ADDRESS:
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> CN134139455-GHC-Cas-22-23 INSURERA:LM Insurance Corporation 33600
<br /> INSURED North State Communications Advanced INSURER B:Liberty Mutual Fire Insurance Company 23035
<br /> Services,LLC INSURER C:Liberty Insurance Corporation 42404
<br /> 4100 Mendenhall Oaks Parkway,Suite 300 INSURER D:
<br /> High Point,NC 27265
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: CLE-006876859-04 REVISION NUMBER: 5
<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/DDIYYYY MM/DD/YYYY
<br /> A X COMMERCIAL GENERAL LIABILITY TB5-Z11-C1J42P-022 10/04/2022 10/04/2023 EACH OCCURRENCE $ 1,000,000
<br /> DAMAGE TO TED
<br /> CLAIMS-MADE � OCCUR PREMISES
<br /> (a occurrence)
<br /> ctcur ence) $ 1,000,000
<br /> MED EXP(Any one person) $ 15,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> X POLICY❑ PRO-
<br /> POLICY [K LOC PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> OTHER: $
<br /> B AUTOMOBILE LIABILITY AS2-Z1 1-C1 J42P-01 2 10/04/2022 10/04/2023 COEaMBINED accidentS INGLE LIMIT $ 1,000,000
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> X OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> X HIRED NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> X UMBRELLA LIAB X OCCUR TH7-Z11-C1J42P-052 10/04/2022 10/03/2023 EACH OCCURRENCE $ 10,000,000
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000
<br /> DED RETENTION$ $
<br /> A WORKERS COMPENSATION WC5-Z1 1-C1 J42P-032 10/04/2022 10/04/2023 X PER oTH-
<br /> AND EMPLOYERS'LIABILITY Y/N STATUTE I I ER
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBER EXCLUDED? ❑N N/A
<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 /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
<br /> Orange County,its departments,agents,employees or assigns is/are included as additional insured(except workers'compensation)where required by written contract.Waiver of subrogation is applicable where
<br /> required by written contract.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> Orange County,North Carolina SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Travis Myren THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> P.O.Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Hillsborough,NC 27278
<br /> AUTHORIZED REPRESENTATIVE
<br /> Vor 2L.Srg 49,cc.
<br /> ©1988-2016 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br />
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