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<br />~~. <br />ACORO~ CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) <br />oa/ii/zoiz <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 be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER 1-713-623-2330 CONTACT geverl Peaka <br />NAME: Y <br />Arthur J. Gallagher Risk Management Services, Inc. PHONE <br />' <br />F'~ <br /> , <br />713-358-5826 <br />713-358-5827 <br />No NC No : <br />1900 West Loop South pppR~ESS: Beverly Peska(~ajg.com <br />Suite 1600 <br />TX 77027 ~ <br />Houston INSURER S AFFORDING COVERAGE NAIC # <br />, <br />Rena Deea 713-358-5758 INSURERA: ~TFORD FIRE IN CO 19682 <br />INSURED INSURERB: GREAT AMER INS CO 16691 <br />Carolina Sunrock, LLC HARTFORD UNDfiRWRITERS INS CO <br />INSURER C : 30104 <br />200 Horizon Drive INSURERD: <br />Suite 100 <br />i INSURERE: <br />Rale <br />gh, NC 27615 <br /> INSURER F: <br />COVERAGES CERTIFICATE NUMBER: 2658413z 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 ADOL SUBR Y EFF <br />~ <br /> <br />LTR 7YPE OF INSURANCE pOLICY NUMBER D <br />MM% MM/DD~ LIMRS <br />A GENErtALLIABILITY X 61iTENOC1082 03/O1/1 03/O1/13 EpCHOCCURRENCE $ 1,000,000 <br /> X COMMERCIAL GENERAL LIABILITY AMAGE O RENTED <br />PREMISES Ea occurtence 500, 000 <br />$ <br /> CLAIMSMADE ~ OCCUR MED EXP (Any one person) $ 10, 000 <br /> PERSONALBADV INJURY $ 1, 000, 000 <br /> GENERALAGGREGATE $ 2.000,000 <br /> GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS-COMP/OPAGG $2.000,000 <br /> X POLICY PR~~ LOC $ <br />A AUTOMOBILELIABILITY X 61IIENOC1407 03 O1 1 03 O1 13 COMBINEDSINGLELIMIT <br />Ea acadent 1,000,000 <br />A X 61LTENOC1081 03/O1/1 03/O1/13 <br /> <br />ANY AUTO gODILYINJURY(Perperson) $ <br /> ALL OWNED <br />AUTOS SCHEDULED <br />AUTOS BODILY INJURY (Per accident) $ <br /> X X NON-0WNED PROPERTY DAMAGE $ <br /> HIRED AUTOS AUTOS Per accident <br /> X $250 Ded. g $500 Ded. g <br />8 X UMBRELLaLIA6 X pCCUR TIIU557817404 03/O1/1 03/O1/13 EqCH OCCURRENCE $ 20,000,000 <br /> EXCESS LIAB CL4IMS-MADE AGGREGATE $ 20, 000, 000 <br /> DED X RETENTION$ 10, 000 $ <br />C WORKERSCOMPENSATION <br />' 61WEOC1080 03~01~1 ~3/O1/13 X WCSTATU- OTH- <br /> AND EMPLOYERS <br />LIABILITY <br /> ANYPROPRIEfOR/PARTNER/EXECUTIVE~ E.L.EACHACCIDENT $ 1,000,000 <br /> OFFICERlMEMBER EXCLUDED7 N N~A <br /> (Mandatory in NH) E.L. DISEASE- EAEMPIOYE $ 1, 000, 000 <br /> If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT 1, 000, 000 <br />$ <br /> <br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD t07, Additional Remarks Schedule, if more space Is requlred) <br />Certificate Holder is named Additional Insured where required by written contract on all policiea except <br />Workera Compensation. <br />Orange County, NC ie granted 30 Days Written Notice of Cancellation, Non-Ranewal or material changa in <br />coverage as required by written contract. <br />See attached for additional coverage information. <br />(_FRTIFI(:ATF Hnl I']FR CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Orange County, NC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br />P.O. BOx 8181 AUTHORI2ED REPRESENTATNE <br />Hillsborough, NC 27278 ?'~/~.~ ~~ <br />USA <br />O 1988-2010 ACORD CORPORATION. Au nghts reservea. <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <br />bevpesk <br />26564132 <br />