CERTIFICATE OF LIABILITY INSURANCE Fuge 1 of 2
CERTIFICATE OF LIABILITY INSURANCE- p l2/SDr6®YVYY) -
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THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE. COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT':. If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.
It SUBROGATION IS WAIVED, subject to the terns and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s),
PRODUCER CONEON 11A ' Willi
AGENCY CUSTOMER ID:
LOC#:
ACC)R" ADDITIONAL REMARKS SCHEDULE Page 2 Of 2
AGENCY NAMED INSURED
Willis Towers Watson Northeast, Inc. Xerox Corporation
201 Merritt 7
POLICY NUMBER Norwalk, CT 068512056
See Page I
CARRIER 14AIC CODE
See Page I See Page I ------ ......
EFFECTiVEDATE: See Page I
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: S!
FORM F�ficate of Liability insurance
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INSURER AFFORDING COVERAGE: ACE Fire underwriters Insurance Company NAIC#: 20702
POLICY NUMBER: SCF 068922318 EFF DATE: 01/01/2022 EXP DATE: 01/01/2023
TYPE OF INSURANCE; LIMIT DESCRIPTION: LIMIT AMOUNT:
Workers compensation and E.L. EACH ACCIDENT $1,000,000
Employers' Liability E.L. DISEASE -EA EMP $1,000,000
Per Statute E.L. DISEASE -POLICY $1,000,000
ADDITIONAL REMARKS:
Policy mentioned above is for Workers Compensation WI,
ACORN 101 (2008/01) 0 2008 ACOR'D CORPORATION, All rights reserved.
The ACORN name and logo are registered marks of ACORD
SR iD: 22011506 BATCH: 2355306 CERT: W23596266