Orange County NC Website
Browse       Search
Holder Identifier : 7777777707070700077763616065553330763735764015474607762215770634132071660557146323320752405777247455007344055716630310077260355720145760770625111267213007724275512274570077727252025773110777777707000707007 6666666606060600062606466204446200602002626224222006220024262040022062222042402400220602200626224002006222204062040202062002042620400200602202626200042006202264222660240066646062240664440666666606000606006Certificate No :570108511865CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) <br /> 09/27/2024 <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 />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 />PRODUCER <br />Aon Risk Services Central, Inc. <br />Chicago IL Office <br />200 East Randolph <br />Chicago IL 60601 USA <br />PHONE <br />(A/C. No. Ext): <br />E-MAIL <br />ADDRESS: <br />INSURER(S) AFFORDING COVERAGE NAIC # <br />(312) 381-1000 <br />INSURED 20303Great Northern Insurance Co.INSURER A: <br />20281Federal Insurance CompanyINSURER B: <br />10052Chubb National Ins CoINSURER C: <br />12777Chubb Indemnity Insurance Co.INSURER D: <br />INSURER E: <br />INSURER F: <br />FAX <br />(A/C. No.):(312) 381-7007 <br />CONTACT <br />NAME: <br />Forvis Mazars, LLP <br />Attn: Scott Henderson <br />910 East St. Louis Street <br />Suite 400 <br />Springfield MO 65806 USA <br />COVERAGES CERTIFICATE NUMBER:570108511865 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 />POLICY EXP <br />(MM/DD/YYYY) <br />POLICY EFF <br />(MM/DD/YYYY) <br />SUBR <br />WVD <br />INSR <br />LTR <br />ADDL <br />INSD POLICY NUMBER TYPE OF INSURANCE LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS-MADE OCCUR <br />POLICY LOC <br />EACH OCCURRENCE <br />DAMAGE TO RENTED <br />PREMISES (Ea occurrence) <br />MED EXP (Any one person) <br />PERSONAL & ADV INJURY <br />GENERAL AGGREGATE <br />PRODUCTS - COMP/OP AGG <br />X <br />X <br />X <br />X X <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />$1,000,000 <br />$1,000,000 <br />$25,000 <br />$1,000,000 <br />$2,000,000 <br />Included <br />Blanket Additional Insured <br />A 09/30/2024 09/30/2025 <br />General Liability <br />30040658 <br />PRO- <br />JECT <br />OTHER: <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />OWNED <br />AUTOS ONLY <br />SCHEDULED <br /> AUTOS <br />HIRED AUTOS <br />ONLY <br />NON-OWNED <br />AUTOS ONLY <br />BODILY INJURY ( Per person) <br />PROPERTY DAMAGE <br />(Per accident)X X <br />BODILY INJURY (Per accident) <br />$1,000,000A09/30/2024 09/30/2025 <br />Auto <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />73628888 <br />EXCESS LIAB <br />X OCCUR <br />CLAIMS-MADE AGGREGATE <br />EACH OCCURRENCE <br />DED <br />$5,000,000 <br />$5,000,000 <br />09/30/2024 <br />Umbrella <br />UMBRELLA LIABB 09/30/202578197191 <br />RETENTION <br />X <br />E.L. DISEASE-EA EMPLOYEE <br />E.L. DISEASE-POLICY LIMIT <br />E.L. EACH ACCIDENT $1,000,000 <br />X OTH- <br />ER <br />PER STATUTEC09/30/2024 09/30/2025 <br />WC (AOS) <br />2470441241D 09/30/2024 09/30/2025 <br />$1,000,000 <br />Y / N <br />(Mandatory in NH) <br />ANY PROPRIETOR / PARTNER / EXECUTIVE <br />OFFICER/MEMBER EXCLUDED?N / AY <br />WC (AK & MS) <br />WORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />$1,000,000 <br />2470441240 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />Orange County, its officers, agents and employees are listed as additional insureds in regards to General Liability and Auto <br />Liability as required by written contract. A waiver of subrogation if favor of the additional insureds in regards to General <br />Liability, Auto Liability and Workers Comp as required by written contract and applicable by law. <br />CANCELLATIONCERTIFICATE HOLDER <br />AUTHORIZED REPRESENTATIVEOrange County <br />300 West Tryon Street <br />P.O. Box 8181 <br />Hillsborough, NC 27278 USA <br />ACORD 25 (2016/03) <br />©1988-2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <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 />Docusign Envelope ID: 183D8F77-022B-48BA-9D7A-59C5C1C4FC1A