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AC'R® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY)
<br /> 11 /25/2024
<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 .
<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 /> Arthur J . Gallagher Risk Management Services , LLC NAME:
<br /> PHONE FAx
<br /> Creekside Crossing Arc o Ext : 615-244-8484 A/c No): 615-377-5101
<br /> 8 Cadillac Drive , Suite 200 A DRIESS :
<br /> Brentwood TN 37027 INSURERS AFFORDING COVERAGE NAIC #
<br /> INSURER A : Travelers Casualty and Surety Company 19038
<br /> INSURED VACOLLC-01 INSURER B : Travelers Casualty and Surety Co of America 31194
<br /> Facility ID #03
<br /> Vaco LLC INSURER C : Ascot Insurance Company 23752
<br /> 5501 Virginia Way, Suite 120 INSURERD : Phoenix Insurance Company 25623
<br /> Brentwood TN 37027 INSURERE : ACE American Insurance Company 22667
<br /> INSURER F : Travelers Casualty Insurance Co of America 19046
<br /> COVERAGES CERTIFICATE NUMBER: 1795623231 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 POLICYNUMBER MM/DD MMIDDIYYYY
<br /> D X COMMERCIAL GENERAL LIABILITY Y Y 630-366M7304 9/15/2024 9/15/2025 EACH OCCURRENCE $ 1 ,000,000
<br /> DAMAGE TO S ( RENTED
<br /> CLAIMS-MADE OCCUR
<br /> PREMISES Ea occurrence) $ 1 ,000,000
<br /> X Contractual Liab MED EXP (Anyone person) $ 10,000
<br /> PERSONAL & ADV INJURY $ 1 ,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> JECT
<br /> POLICY ❑ PRO ❑ LOC PRODUCTS - COMP/OP AGG $ 2,000,000
<br /> X
<br /> OTHER: $
<br /> A AUTOMOBILE LIABILITY Y Y BA-5Y65820A 9/15/2024 9/15/2025 COMBINED SINGLE LIMIT $ 1 ,000,000
<br /> 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 /> comp/colideductible $ 1 ,000/$ 1 ,000
<br /> B X UMBRELLA LIAB X OCCUR Y Y CUP-5Y703794 9/15/2024 9/15/2025 EACH OCCURRENCE $ 253000,000
<br /> EXCESS LIAR 1-1 CLAIMS-MADE AGGREGATE $ 25,000,000
<br /> DED RETENTION $ $
<br /> E WORKERS COMPENSATION Y (25) 71834794 9/15/2024 9/15/2025 X PER OTH-
<br /> AND EMPLOYERS' LIABILITY YIN STATUTE ER
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE
<br /> Fq
<br /> OFFICER/MEMBEREXCLUE N / A E.L. EACH ACCIDENT $ 1 ,000,000
<br /> (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 13000,000
<br /> If yes, describe under
<br /> DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1 ,0003000
<br /> F Primary Cyber/ Tech E&O ZPP-51N86155 9/15/2024 9/15/2025 Per Claim/Agg $51000,000
<br /> C Excess Cyber/ Tech E&O EOXS2410001905-02 9/15/2024 9/15/2025 Per Claim/ Agg $53000,000
<br /> DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101 , Additional Remarks Schedule, maybe attached If more space is required)
<br /> If required by written contract, Certificate Holder is included as additional insured on the General Liability Per Form Per form CG D2 46 04 19 per written
<br /> contract; Automobile Liability per Per form CA T4 74 02 16 , Cyber/ Tech E&O per written contract per form CYB-16002 Ed . 06-20. The insurance provided in
<br /> the General Liability Per form CG T1 00 02 19 , Automobile Liability per Per form CA T4 74 02 16 is primary and non contributing . Waiver of subrogation applies
<br /> to certificate holder as respects Commercial General Liability-Per form CG T1 00 02 19 ; Property per form DX T1 00 11 12 , Workers Compensation per form
<br /> WC 000313 ; Automobile-Per form CA T3 53 02 15 , Cyber/Tech E&O- per form CYB-16002 Ed . 06-20 . Umbrella Liability is follow form . Contractual Liability
<br /> per written contract is included on General Liability. Business Interruption/ Income Insurance applies to the property policy per form IL T3 18 05 11 and cyber
<br /> policy per form DX T4 17 .
<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 /> ACCORDANCE WITH THE POLICY PROVISIONS ,
<br /> Orange County Government of North Carolina
<br /> 405 Meadowlands Drive PO Box 8181
<br /> Hillsborough NC 27278 AUTHORIZED REPRESENTATIVE
<br /> © 1988-2015 ACORD CORPORATION . All rights reserved .
<br /> ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
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