|
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:CONTACT
<br />(A/C, No):FAX
<br />E-MAILADDRESS:
<br />PRODUCER
<br />(A/C, No, Ext):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 />$PROPERTY DAMAGE
<br />BODILY INJURY (Per accident)
<br />BODILY INJURY (Per person)
<br />COMBINED SINGLE LIMIT
<br />AUTOS ONLY
<br />AUTOSAUTOS ONLY NON-OWNED
<br />SCHEDULEDOWNED
<br />ANY AUTO
<br />AUTOMOBILE LIABILITY
<br />Y / N
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />DESCRIPTION OF OPERATIONS below
<br />If yes, describe under
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />$
<br />$
<br />$
<br />E.L. DISEASE - POLICY LIMIT
<br />E.L. DISEASE - EA EMPLOYEE
<br />E.L. EACH ACCIDENT
<br />EROTH-STATUTEPER
<br />LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR
<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-JECT LOC
<br />CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
<br />CANCELLATION
<br />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2016/03)
<br />© 1988-2015 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 />6/17/2024
<br />Arthur J.Gallagher Risk Management Services,LLC
<br />Six Desta Drive,Suite 5900
<br />Midland TX 79705
<br />432-570-3456 432-570-3450
<br />Associated Indemnity Corporation 21865
<br />CATALIS-01 Charter Oak Fire Insurance Company 25615CatalisTax&CAMA,Inc.
<br />3025 Windward Plaza Ste 200
<br />Alpharetta GA 30005
<br />Travelers Property Casualty Co of America 25674
<br />Phoenix Insurance Company 25623
<br />Travelers Casualty and Surety Company 19038
<br />1776855652
<br />D X 1,000,000
<br />X 300,000
<br />10,000
<br />1,000,000
<br />2,000,000
<br />X
<br />Y Y H-630-2Y488107-PHX-24 6/20/2024 5/20/2025
<br />2,000,000
<br />B 1,000,000
<br />X
<br />X X
<br />Y Y BA-2Y489952-24-I3-G 6/20/2024 5/20/2025
<br />C X X 5,000,000YCUP-3Y654799-24-I3 6/20/2024Y 5/20/2025
<br />5,000,000
<br />X 10,000
<br />E X
<br />N
<br />Y UB-2Y488979-24-I3-G 6/20/2024 5/20/2025
<br />1,000,000
<br />1,000,000
<br />1,000,000
<br />A Professional Liability
<br />Cyber Liability
<br />Y
<br />Y AES1234141-01 6/20/2024 5/20/2025 Professional
<br />Cyber
<br />$5,000,000
<br />$5,000,000
<br />Certificate Holder is an Additional Insured as respects to the General Liability,Automobile,Cyber/Professional policies,pursuant to the policy’s terms,
<br />definitions,conditions and exclusions,as per endorsement CG D4 17 edition (02 19),CA T3 01 edition (02 15),and CYS 0122.
<br />Waiver of Subrogation applies to certificate holder,as respects to the General Liability,Automobile,Cyber/Professional policies and Workers Compensation
<br />pursuant to the policy’s terms,definitions,conditions and exclusions,as per endorsement CG D4 17 edition (02 19),CA T3 53,edition (02 15),CYS 0122,
<br />WC00031300.
<br />The insurance provided in the General Liability policy is primary and noncontributing as per endorsement CG T1 00 edition (02 19).
<br />See Attached...
<br />Orange County NC
<br />228 S.Churton Street
<br />Hillsborough NC 27278
<br />USA
<br />Docusign Envelope ID: 4993F44A-8F95-4FF7-B151-31AAC2826252
|