|
DocuSign Envelope ID:42768609-3F6E-4668-8792-E66DBE7E5727
<br /> CERTIFICATE OF LIABILITY INSURANCE FD,29(MM/DD/YYYY)
<br /> 1 9/28/2023
<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 /> PRODUCER CONTACT
<br /> NAME: AJG Service Team
<br /> Arthur J. Gallagher Risk Management Services, LLC PHONE FAx
<br /> 300 Madison Avenue WC,
<br /> /c No Ext): 212-994-7100 A/C No):212-994-7047
<br /> E-M28th Floor ADDRESS: GGB.WSPUS.CERTREQUESTS@AJG.com
<br /> New York NY 10017 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURERA: Liberty Insurance Corporation 42404
<br /> INSURED WSPGLOB-01 INSURER B:Zurich American Insurance Company 16535
<br /> WSP USA Inc.
<br /> One Penn Plaza INSURER C:American Guarantee and Liability Ins Cc 26247
<br /> New York, NY 10119 INSURER D:AXIS Surplus Insurance Company 26620
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:1425731024 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.
<br /> INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD POLICYNUMBER MM/DD/YYYY MM/DD/YYYY
<br /> B X COMMERCIAL GENERAL LIABILITY GLO 9835819-10 5/1/2023 5/1/2024 EACH OCCURRENCE $3,500,000
<br /> CLAIMS-MADE � OCCUR DAMAGE O RENTED
<br /> PREMISESTEa occurrence $3,500,000
<br /> MED EXP(Any one person) $10,000
<br /> PERSONAL&ADV INJURY $3,500,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $7,000,000
<br /> POLICY❑ PRO-
<br /> JECT ❑ LOC PRODUCTS-COMP/OP AGG $4,000,000
<br /> X
<br /> OTHER: $
<br /> A AUTOMOBILE LIABILITY AS7-621-094060-033 5/1/2023 5/1/2024 COMBINED SINGLE LIMIT $5,000,000
<br /> D P-001-001008908-02 5/1/2023 5/1/2024 Ea accident
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> HIRED NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> XS COMB.SINGLE LIMIT $5,000,000
<br /> C X UMBRELLA LIAB X OCCUR AUC 00144386-07 5/1/2023 5/1/2024 EACH OCCURRENCE $3,000,000
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $3,000,000
<br /> DED X RETENTION$ $
<br /> A WORKERS COMPENSATION WA7-62D-094060-013 5/1/2023 5/1/2024 X PER OTH-
<br /> A AND EMPLOYERS'LIABILITY Y/N WA7-62D-095609-073 5/1/2023 5/1/2024 STATUTE ER
<br /> A ANYPROPRIETOR/PARTNER/EXECUTIVE WC7-621-094060-913 5/1/2023 5/1/2024 E.L.EACH ACCIDENT $2,000,000
<br /> OFFICER/MEMBER EXCLUDED? N N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $2,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $2,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> THIRTY(30)DAYS NOTICE OF CANCELLATION.
<br /> Project Number:202306079.Project Description:Orange County TMP.
<br /> Orange County,its officers,agents and employees are included as Additional Insured with respect to the General Liability and Automobile Liability policies as
<br /> required by written agreement,pursuant to and subject to the policy's terms,definitions,conditions and exclusions.Waiver of Subrogation applies to Additional
<br /> Insured with respect to the Workers Compensation/Employers Liability policies as required by written agreement,pursuant to and subject to the policy's terms,
<br /> definitions,conditions and exclusions.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Orange County ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 300 West Tryon Street
<br /> PO Box 8181 AUTHORIZED REPRESENTATIVE
<br /> Hillsborough NC 27278
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br />
|