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Docusign Envelope ID: B576D624-E16E-4D9F-BC67-5703DE54A6F8
<br /> INNOEME-01 LHAMLET
<br /> ,4coR0 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
<br /> 3/5/2025
<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 Lori F. Hamlet
<br /> NAME:
<br /> Alera Group PHONE FAX
<br /> 4131 Parklake Avenue,Suite 225 (A/C,No,Ext): (919)469-2473 (A/C,No):(919)467-4987
<br /> Raleigh,NC 27612 ADDRESS:(hamlet@trisure.com
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURER A:Phoenix Insurance Company The 25623
<br /> INSURED INSURER B:Travelers Property Casualty Company of America 25674
<br /> IEM International,Inc. INSURER C:Landmark American Insurance 33138
<br /> 2801 Slater Rd,Ste 200 INSURER D:Axis Surplus Insurance Company 26620
<br /> Morrisville,INC 27560
<br /> INSURER E
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 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 NUMBER POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD MM DD YYY MM DD YYY
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X OCCUR 630 3R329314 10/1/2024 10/1/2025 DAMAGE TO RENTED 1,000,000
<br /> X PREMISES Ea occurrence $
<br /> MED EXP(Any oneperson) $ 10,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> X POLICY�X PRO
<br /> POLICY �X LOC PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> OTHER: EMPLOYEE BENEFI $ 3,000,000
<br /> B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
<br /> Ea accident $
<br /> ANY AUTO BA3R329191 10/1/2024 10/1/2025 BODILY INJURY Perperson) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY Per accident $
<br /> X HIRED X NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY Per accident)
<br /> ent $
<br /> B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000
<br /> EXCESS LIAB CLAIMS-MADE CUP 3R389058 10/1/2024 10/1/2025 AGGREGATE $ 10,000,000
<br /> DED X RETENTION$ 10,000 $
<br /> B WORKERS COMPENSATION X PER OTH-
<br /> ANDEMPLOYERS'LIABILITY STATUTE ER
<br /> U B3R328606 10/1/2024 10/1/2025 1,000,000
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE N/A X E.L.EACH ACCIDENT $
<br /> OFFICER/MEMBER EXCLUDED?
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> C Professional/Cyber LCY861481 10/1/2024 10/1/2025 Limit 5,000,000
<br /> D Excess Prof/Cyber P00100124587302 10/1/2024 10/1/2025 Limit 5,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> RFP#367-005435,IEM Project Number:20669
<br /> Orange County,its officers,official agents and employees are included as additional insureds with respects to General Liability if required by written contract.
<br /> A waiver of subrogation is applicable for Orange County,its officers,official agents and employees with respects to Workers Compensation if required by
<br /> written contract. A 30 day notice of cancellation applies.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> NC Orange Count THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> 9 y ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Attn: Melissa Tegeder/Risk Manager
<br /> 200 South Cameron Street
<br /> Hillsborough,INC 27278 AUTHORIZED REPRESENTATIVE
<br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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