Orange County NC Website
DocuSign Envelope ID:7E694176-9E31-49DB-A1E4-AFB129905EB1 <br /> DATE(MM/DD/YYYY) <br /> A�o CERTIFICATE OF LIABILITY INSURANCE I <br /> 03/12/2024 <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.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 /> PRODUCER CONTACT W <br /> Aon Risk services Northeast, Inc. PHONE FAX i' <br /> New York NY Office (A/C.No.Ext): (866) 283-7122 (A/C.No.): 800-363-0105 <br /> one Liberty Plaza E-MAIL p <br /> 165 Broadway, Suite 3201 ADDRESS: _ <br /> New York NY 10006 USA <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURED INSURER A: Greenwich Insurance Company 22322 <br /> Honeywell International Inc. INSURERB: XL Insurance America Inc 24554 <br /> 855 s. Mint <br /> Charlotte INC 28202 USA INSURERC: XL Insurance Company SE AAl-121547 <br /> INSURER D: XL Specialty Insurance Co 137885 <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 570104297426 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 /> INSR TYPE OF INSURANCE ADD SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS <br /> LTR INSD WVD MM/DD/YYYY MM/DD/YYYY <br /> A X COMMERCIAL GENERAL LIABILITY Y Y RGC 4 7 4 0410112024 EACH OCCURRENCE $5,000,000 <br /> CLAIMS-MADE X❑OCCUR DAMAGE TO RENTED $5,000,000 <br /> PREMISES Ea occurrence <br /> MED EXP(Any one person) $50,000 <br /> PERSONAL&ADV INJURY $5,000,000 N <br /> GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $5,000,000 <br /> X POLICY ❑PRO- <br /> JECTLOC PRODUCTS-COMP/OPAGG Included o <br /> OTHER: o <br /> A Y Y RAC943764210 04/01/2023 04/01/2024 COMBINED SINGLE LIMIT <br /> AUTOMOBILE LIABILITY $1,OOO,OOO <br /> A05 Ea accident <br /> X ANYAUTO BODILY INJURY(Per person) o <br /> Z <br /> OWNED SCHEDULED BODILY INJURY(Per accident) 0) <br /> AUTOS ONLY AUTOS j6 <br /> HIREDAUTOS NON-OWNED PROPERTY DAMAGE V <br /> ONLY AUTOS ONLY Per accident w_ <br /> 'C <br /> N <br /> '4 UMBRELLA LIAB X OCCUR RA0943764510 04/01/2023 04/01/2024 EACH OCCURRENCE $4,000,000 U <br /> EXCESS LIAB CLAIMS-MAD <br /> E Excess Auto AGGREGATE <br /> DED RETENTION <br /> B WORKERS COMPENSATION AND Y RWD943540310 04/01/2023 04/01/2024 X I PERSTATUTE I OTH- <br /> EMPLOYERS'LIABILITY Y/N AOS ER <br /> C ANY PROPRIETOR/PARTNER/EXECUTIVE y RWC943540210 04/Ol/2023 04/Ol/2024 E.L.EACH ACCIDENT $5,000,000 <br /> OFFICER/MEMBER EXCLUDED? N/A <br /> (Mandatory in NH) AK, WI E.L.DISEASE-EA EMPLOYEE $5,000,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $5,000,000 <br /> -_ <br /> D Excess workers Compensation RWE943540410 04/01/2023 04/01/2024 EL Each Accident $5,000,000 <br /> AZ, OH, WA EL Disease - Ea Emp' $5,000,000 <br /> SIR applies per policy ter s & condi ions EL Annual Aggregate $5,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 2 <br /> orange County is included as Additional Insured for the General Liability and Auto policies with respect to Honeywell <br /> operations in connection with Honeywell International, Inc. Coverage is Primary and Non-Contributory for the General Liability <br /> and Automobile Liability policies. Waiver of Subrogation is granted in favor of orange County for the General Liability, = <br /> Automobile Liability and Workers' Compensation policies where required by written contract. <br /> MF <br /> CERTIFICATE HOLDER CANCELLATION <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 /> Orange County AUTHORIZED REPRESENTATIVE F <br /> PO Box 8181 <br /> Hillsborough NC 27278 USA <br /> e.]40�d i�GdO1G r�saG�Y.d�O c//�eJ� <br /> ©1988-2015 ACORD CORPORATION.All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />