Orange County NC Website
The ACORD name and logo are registered marks of ACORD <br />CERTIFICATE HOLDER <br />© 1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) <br />AUTHORIZED REPRESENTATIVE <br />CANCELLATION <br />DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE <br />LOCJECT <br />PRO-POLICY <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />OCCURCLAIMS-MADE <br />COMMERCIAL GENERAL LIABILITY <br />PREMISES (Ea occurrence)$ <br />DAMAGE TO RENTED <br />EACH OCCURRENCE $ <br />MED EXP (Any one person)$ <br />PERSONAL & ADV INJURY $ <br />GENERAL AGGREGATE $ <br />PRODUCTS - COMP/OP AGG $ <br />$RETENTIONDED <br />CLAIMS-MADE <br />OCCUR <br />$ <br />AGGREGATE $ <br />EACH OCCURRENCE $UMBRELLA LIAB <br />EXCESS LIAB <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />INSRLTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)LIMITS <br />PER <br />STATUTE <br />OTH- <br />ER <br />E.L. EACH ACCIDENT <br />E.L. DISEASE - EA EMPLOYEE <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />$ <br />$ <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />(Mandatory in NH)OFFICER/MEMBER EXCLUDED? <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />OWNED SCHEDULED <br />HIRED NON-OWNED <br />AUTOS ONLY AUTOS <br />AUTOS ONLY AUTOS ONLY <br />COMBINED SINGLE LIMIT <br />BODILY INJURY (Per person) <br />BODILY INJURY (Per accident) <br />PROPERTY DAMAGE $ <br />$ <br />$ <br />$ <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 />INSD <br />ADDL <br />WVD <br />SUBR <br />N / A <br />$ <br />$ <br />(Ea accident) <br />(Per accident) <br />OTHER: <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 />COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: <br />INSURED <br />PHONE(A/C, No, Ext): <br />PRODUCER <br />ADDRESS:E-MAIL <br />FAX(A/C, No): <br />CONTACTNAME: <br />NAIC # <br />INSURER A : <br />INSURER B : <br />INSURER C : <br />INSURER D : <br />INSURER E : <br />INSURER F : <br />INSURER(S) AFFORDING COVERAGE <br />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 />1/26/2017 <br />Arthur J. Gallagher Risk Management Services, Inc. <br />1300 South Main Street <br />Tulsa OK 74119 <br />TMA Holdings, LLC <br />5100 E Skelly Dr, Ste 900 <br />Tulsa OK 74135 <br />Federal Insurance Company 20281 <br />Suzanne Baldwin <br />918-584-1433 918-582-1329 <br />suzanne_baldwin@ajg.com <br />TMAHOLD-03 <br />1652186239 <br />A Professional Liability 99486368WCE 12/22/2016 12/22/2017 Annual Aggregate 4,000,000 <br />For Information Only <br />. <br />. . . <br />DocuSign Envelope ID: D1041CA6-DBD4-42BE-8B32-7C592BF2BA15DocuSign Envelope ID: 3E613CA5-0A37-4CD3-890F-47CC5E2F38B1