|
GovClient LiabHolder Identifier : 7777777707070700077761616045571110767735324015474207663304671635132070671557046332320717051333343000107215110746264610077665240764555370734235551277613007365224543375120076727242035772000777777707000707007 7777777707070700073525677115456000777414047037557507231510574233466075726733561275500753727660317745007133326342073101070332262430621110712332724207311007132326243173101077756163351765540777777707000707007Certificate No : 570102191854 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
<br /> 10/10/2023
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If
<br />SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this
<br />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 />PRODUCER
<br />Aon Risk Services Central, Inc.
<br />Philadelphia PA Office
<br />100 North 18th Street
<br />15th Floor
<br />Philadelphia PA 19103 USA
<br />PHONE
<br />(A/C. No. Ext):
<br />E-MAIL
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />(866) 283-7122
<br />INSURED 40142American Zurich Ins CoINSURER A:
<br />16535Zurich American Ins CoINSURER B:
<br />37885XL Specialty Insurance CoINSURER C:
<br />11515QBE Specialty Insurance CompanyINSURER D:
<br />INSURER E:
<br />INSURER F:
<br />FAX
<br />(A/C. No.):(800) 363-0105
<br />CONTACT
<br />NAME:
<br />Maximus US Services, Inc.
<br />1600 Tysons Boulevard, Suite 1400
<br />McLean VA 22102 USA
<br />COVERAGES CERTIFICATE NUMBER:570102191854 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.Limits shown are as requested
<br />POLICY EXP
<br />(MM/DD/YYYY)
<br />POLICY EFF
<br />(MM/DD/YYYY)
<br />SUBR
<br />WVD
<br />INSR
<br />LTR
<br />ADDL
<br />INSD POLICY NUMBER TYPE OF INSURANCE LIMITS
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS-MADE OCCUR
<br />POLICY LOC
<br />EACH OCCURRENCE
<br />DAMAGE TO RENTED
<br />PREMISES (Ea occurrence)
<br />MED EXP (Any one person)
<br />PERSONAL & ADV INJURY
<br />GENERAL AGGREGATE
<br />PRODUCTS - COMP/OP AGG
<br />X
<br />X
<br />X
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />$2,000,000
<br />$2,000,000
<br />$10,000
<br />$2,000,000
<br />$4,000,000
<br />$4,000,000
<br />B 05/01/2023 05/01/2024GLO509621808
<br />PRO-
<br />JECT
<br />OTHER:
<br />AUTOMOBILE LIABILITY
<br />ANY AUTO
<br />OWNED
<br />AUTOS ONLY
<br />SCHEDULED
<br /> AUTOS
<br />HIRED AUTOS
<br />ONLY
<br />NON-OWNED
<br />AUTOS ONLY
<br />BODILY INJURY ( Per person)
<br />PROPERTY DAMAGE
<br />(Per accident)
<br />X
<br />BODILY INJURY (Per accident)
<br />$2,000,000B05/01/2023 05/01/2024 COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />BAP 5096219 08
<br />EXCESS LIAB
<br />X OCCUR
<br />CLAIMS-MADE AGGREGATE
<br />EACH OCCURRENCE
<br />DED
<br />$10,000,000
<br />$10,000,000
<br />$10,000
<br />05/01/2023UMBRELLA LIABC 05/01/2024US00075267LI23A
<br />RETENTIONX
<br />X
<br />E.L. DISEASE-EA EMPLOYEE
<br />E.L. DISEASE-POLICY LIMIT
<br />E.L. EACH ACCIDENT $1,000,000
<br />X OTH-
<br />ER
<br />PER STATUTEA05/01/2023 05/01/2024
<br />Deductible $350,000
<br />WC509621708A 05/01/2023 05/01/2024
<br />$1,000,000
<br />Y / N
<br />(Mandatory in NH)
<br />ANY PROPRIETOR / PARTNER / EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED?N / AN
<br />Wisconsin
<br />WORKERS COMPENSATION AND
<br />EMPLOYERS' LIABILITY
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />$1,000,000
<br />WC509621608
<br />Ea Occ/Agg10003989208/01/2023 08/01/2024
<br />Claims Made $25,000,000SIR
<br />E&O - Professional Liability
<br />- Primary
<br />D
<br />SIR applies per policy terms & conditions
<br />$10,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br /> Cyber Liability, Network Interruption, Security & Privacy Liability and Media Content Liability included in E&O policy.
<br />Severability of Interest Clause included under General Liability policy. RE: 9873 - NC CO Orange CAP/EMS 23-25. Certificate
<br />Holder is included as Additional Insured in accordance with policy provisions of General Liability, Automobile Liability,
<br />Umbrella Liability and Professional Liability policies. General Liability, Automobile Liability and Umbrella Liability
<br />policies evidenced herein are Primary and Non Contributory to other insurance available to an Additional Insured in accordance
<br />with the policy's provisions. Waiver of Subrogation granted in favor of Certificate Holder in accordance with policy
<br />provisions of General Liability, Automobile Liability, Professional Liability and Workers' Compensation policies.
<br />CANCELLATIONCERTIFICATE HOLDER
<br />AUTHORIZED REPRESENTATIVEOrange County, North Carolina
<br />PO Box 8181, 131 W. Margaret Ln.
<br />Suite 333
<br />Hillsborough NC 27278 USA
<br />ACORD 25 (2016/03)
<br />©1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
<br />POLICY PROVISIONS.
<br />DocuSign Envelope ID: 63E8AFC2-6818-4EB5-A9FB-757FB6CF8B11
|