|
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 />11/25/2024
<br />Arthur J.Gallagher Risk Management Services,LLC
<br />Creekside Crossing
<br />8 Cadillac Drive,Suite 200
<br />Brentwood TN 37027
<br />615-244-8484 615-377-5101
<br />Travelers Casualty and Surety Company 19038
<br />VACOLLC-01 Travelers Casualty and Surety Co of America 31194FacilityID#03
<br />Vaco LLC
<br />5501 Virginia Way,Suite 120
<br />Brentwood TN 37027
<br />Ascot Insurance Company 23752
<br />Phoenix Insurance Company 25623
<br />ACE American Insurance Company 22667
<br />Travelers Casualty Insurance Co of America 19046
<br />1795623231
<br />D X 1,000,000
<br />X 1,000,000
<br />X Contractual Liab 10,000
<br />1,000,000
<br />2,000,000
<br />X
<br />Y Y 630-366M7304 9/15/2024 9/15/2025
<br />2,000,000
<br />A 1,000,000
<br />X
<br />Y Y BA-5Y65820A 9/15/2024 9/15/2025
<br />comp/coll deductible 1,000/$1,000
<br />B X X 25,000,000YCUP-5Y703794 9/15/2024Y 9/15/2025
<br />25,000,000
<br />E X
<br />N
<br />Y (25)71834794 9/15/2024 9/15/2025
<br />1,000,000
<br />1,000,000
<br />1,000,000
<br />F
<br />C
<br />Primary Cyber/Tech E&O
<br />Excess Cyber/Tech E&O ZPP-51N86155
<br />EOXS2410001905-02
<br />9/15/2024
<br />9/15/2024
<br />9/15/2025
<br />9/15/2025
<br />Per Claim/Agg
<br />Per Claim/Agg
<br />$5,000,000
<br />$5,000,000
<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 />Orange County Government of North Carolina
<br />405 Meadowlands Drive PO Box 8181
<br />Hillsborough NC 27278
<br />Docusign Envelope ID: A49E69E0-E69F-42F1-9A36-2871EA644137
|