Orange County NC Website
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 />INSURER(S) AFFORDING COVERAGE <br />INSURER F : <br />INSURER E : <br />INSURER D : <br />INSURER C : <br />INSURER B : <br />INSURER A : <br />NAIC # <br />NAME: <br />CONTACT <br />(A/C, No): <br />FAX <br />E-MAIL <br />ADDRESS: <br />PRODUCER <br />(A/C, No, Ext): <br />PHONE <br />INSURED <br />REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES <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 />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 />OTHER: <br />(Per accident) <br />(Ea accident) <br />$ <br />$ <br />N / A <br />SUBR <br />WVD <br />ADDL <br />INSD <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 />$ <br />$ <br />$ <br />$PROPERTY DAMAGE <br />BODILY INJURY (Per accident) <br />BODILY INJURY (Per person) <br />COMBINED SINGLE LIMIT <br />AUTOS ONLY <br />AUTOSAUTOS ONLY <br />NON-OWNED <br />SCHEDULEDOWNED <br />ANY AUTO <br />AUTOMOBILE LIABILITY <br />Y / N <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH) <br />DESCRIPTION OF OPERATIONS below <br />If yes, describe under <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />$ <br />$ <br />$ <br />E.L. DISEASE - POLICY LIMIT <br />E.L. DISEASE - EA EMPLOYEE <br />E.L. EACH ACCIDENT <br />ER <br />OTH- <br />STATUTE <br />PER <br />LIMITS(MM/DD/YYYY) <br />POLICY EXP <br />(MM/DD/YYYY) <br />POLICY EFF <br />POLICY NUMBERTYPE OF INSURANCELTR <br />INSR <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />EXCESS LIAB <br />UMBRELLA LIAB $EACH OCCURRENCE <br />$AGGREGATE <br />$ <br />OCCUR <br />CLAIMS-MADE <br />DED RETENTION $ <br />$PRODUCTS - COMP/OP AGG <br />$GENERAL AGGREGATE <br />$PERSONAL & ADV INJURY <br />$MED EXP (Any one person) <br />$EACH OCCURRENCE <br />DAMAGE TO RENTED $PREMISES (Ea occurrence) <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS-MADE OCCUR <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY PRO- <br />JECT LOC <br />CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) <br />CANCELLATION <br />AUTHORIZED REPRESENTATIVE <br />ACORD 25 (2016/03) <br />© 1988-2016 ACORD CORPORATION. All rights reserved. <br />CERTIFICATE HOLDER <br />The ACORD name and logo are registered marks of ACORD <br />HIRED <br />AUTOS ONLY <br />1,000,000 <br />10/01/2023 <br />N/A <br />GLD1110114 <br />X <br />TWXJUB-7440L338-TIL-22 (OH) <br />NYC-009196547-31 <br />1,000,000 <br />UB-8P79233A-22-51-R (AZ,MA,WI) <br />X <br />25674 <br />of Marsh USA LLC <br />N <br />X10/01/2022 <br />10/01/2023 <br />N/A <br />N/A <br />TC2J-CAP-7440L34A-TIL-22 <br />B <br />10,000,000 <br />1,000,000 <br />X <br />'''''''''''$500K LIMIT / $500K SIR''''''''''' <br />25658 <br />Travelers Property Casualty Co. of America <br />1,000,000 <br />X <br />X <br />05/02/2023 <br />4433 <br />10/01/2022 <br />10/01/2022 <br />RE: JOB NO. N/A <br /> <br />X <br />10/01/2022 <br /> PO BOX 8181 <br /> HILLSBOROUGH, NC 27278 <br /> ORANGE COUNTY <br />SEE ATTACHED <br />A <br />B <br />The Travelers Indemnity Company <br />CN102147003-RAM--22/23 <br />100,000 <br />10/01/2023 <br />2,000,000 <br />C <br />INCL <br />41343 <br />1,000,000 <br />RENTA <br />1,000,000 <br />X <br />UB-8P83929A-22-51-K (AOS) <br /> 445 SOUTH STREET <br /> MARSH USA, LLC. <br /> MORRISTOWN, NJ 07960-6454 <br /> 1000 DEERFIELD PARKWAY <br /> SIEMENS INDUSTRY, INC. <br /> BUFFALO GROVE, IL 60089-4513 <br />10/01/2022 <br /> ATTN: RISK MANAGEMENT <br />NOC60 <br />B <br />... <br />10/01/2023 <br />10/01/2023 <br />HDI Global Insurance Company <br />DocuSign Envelope ID: DB053680-38C3-450E-AF31-FC6CE9F0C665