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A`i) O ll® <br />INUA i t OF LIABILITY INSURANCE 04/11/2012 ' <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY <br />AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE <br />A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE <br />HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, <br />the policy(Ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain <br />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 1113- 623 -2330 CONTACT <br />Arthur J. Gallagher Risk Management Services, NAME: Beverly Peaks <br />Inc. <br />PHONE <br />1900 West Loop South No 713- 358 -5826 F' <br />E,. A/C No: 713- 358 -5827 <br />E-MAIL E- <br />Suite 1600 ADDRESS: Beverly Peska @aig.com <br />Houston, TX 77027 - INSURERS AFFORDING COVERAGE <br />Rena Dees 713- 358 -5758 NAICN <br />INSURED INSURERA: HARTFORD FIRE IN CO 19682 <br />Carolina Sunrock, LLC INSURERS: GREAT AMER INS CO 16691 <br />INSURERC: HARTFORD UNDERWRITERS INS CO 30104 <br />200 Horizon Drive <br />Suite 100 INSURER D: <br />Raleigh, NC .27615 INSURER E: <br />INSURER F <br />COVERAGES CERTIFICATE NUMBER: 26584132 <br />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, <br />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 <br />BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE <br />INSR BEEN REDUCED BY PAID CLAIMS. <br />A TYPE ADOL SUER <br />INSURANCE POLICY NUMBER MMIDDY/YY1 Y hPjfNpp IXP LIMITS <br />A <br />ry <br />GENERALUA61LrrY X 61UENOC1082 03/01/1 03/01/13 EACH OCCURR 1'000'000 <br />X ENCE $ <br />COMMERCIAL GENERAL LIABILITY G O <br />X PREMISES Ea ooclsra ce $ 500,000 <br />CLAIMS -MADE OCCUR <br />MED EXP (Airy one person) $ 10,000 <br />PERSONAL& ADV INJURY $ 1,000,000 <br />GENERAL AGGREGATE $ 2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />X PRO _ PRODUCTS- COMP /OP AGG $ 2,000,000 <br />POLICY <br />LOC <br />$ <br />A AUTOM0131LELIABILITY X 61UENOC1407 <br />SINGLE LM <br />A X 61UENOC1081 Ea acednt 1,000,000 <br />ANY AUTO 03/01/1 03/01/13 <br />ALL OWNED SCHEDULED BODILY INJURY (Per person) $ <br />AUTOS AUTOS <br />X NON -OWNED BODILY INJURY (Per accident) $ <br />HIRED AUTOS 8 AUTOS PReOPE�Rd Y DAMAGE $ <br />X $250 Ded, g $500 Ded. <br />H <br />X <br />OCCUR <br />TUU557817404 <br />03/01/1 <br />03/01/13 <br />EACH OCCURRENCE <br />$ 20,000,000 <br />��RETENTION <br />EXCESS <br />CLAIMS -MADE <br />AGGREGATE <br />$ 20,000,000 <br />$ 10, 000 <br />C <br />WORKERS COMPENSATION <br />AND EMPLOYERS'LUU31L1TY <br />61WEDC1080 <br />03/01/1 <br />03/01/13 <br />X WC STATU- OTH- <br />TORY UMITS ER <br />$ <br />YIN <br />ANYPROPRIETOR/PARTNER/EXECUiIVE <br />OFFICERIMEMBER EXCLUDED? NN <br />N/A <br />E.L. EACH ACCIDENT <br />$ 1,000,000 <br />(Mandatory in NH) <br />E.L. DISEASE - EA EMPLOYEO <br />$ 1, 000, 000 <br />yes, d <br />If es, describe under <br />DESCRIPTION OF OPERATIONSbeI— <br />E.L. DISEASE - POLICY LIMIT 1 <br />$ 1,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS f VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />Certificate Holder is named Additional Insured where required by written contract on all policies except <br />Workers Compensation. <br />Orange County, NC is granted 30 Days Written Notice of Cancellation, Non - Renewal or material change in <br />coverage as required by written contract. <br />See attached for additional coverage information. <br />r`CDTICIPATC L1111 - <br />W 1 Uoo -cu 1 U HL,UKLI L UKt'UKA I IUN. All rights reserved. <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <br />bevpesk <br />26584132 <br />LLLr1 1 1 V IY <br />Orange County; NC <br />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 />P.O. Box 8181 <br />AUTHORIZED REPRESENTATIVE <br />Hillsborough, NC 27278 <br />USA <br />W 1 Uoo -cu 1 U HL,UKLI L UKt'UKA I IUN. All rights reserved. <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <br />bevpesk <br />26584132 <br />