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/ ) ® <br /> �'►�� CERTIFICATE OF LIABILITY INSURANCE OP ID SF DATE(MMIDDIYYYY) <br /> 08/27/13 <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 poicy(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 NAME: FAX <br /> First Insurance $erV1CPS, Inc. A/C No,Ext: (AIC,NO): <br /> P. 0. BOX 13687 ADDRESS: <br /> R)D RTP NC 27709 CUSTOMERID#: CIVIL-2 <br /> Phone:919-941-0549 Fax:919-941-0135 INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURED INSURERA: Penn. Natl. Mutual Cas. Co. 14990 <br /> Civil Consultants, Inc. INSURER B: Hartford Casualty Insurance Co 29424 <br /> 3708 Lyckan Parkway Ste 201 <br /> Durham NC 27707 INSURERC: _ <br /> INSURER D: <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 CONOTION OF ANY CONTRACTOR 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 /> ILTR TYPE OF INSURANCE INSR WV POLICY �(MM/DD/YYY`) (MM/DDIYYXYY) <br /> LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $1000000 <br /> A X COMMERCIAL GENERAL LIABILITY BP90696427 04/24/13 04/24/14 PREMISES(Ea occurrence) $50000 <br /> CLAIMS-MADE F-1 OCCUR M ED EXP(Anyone person) $_5000 <br /> PERSONAL&ADV INJURY $ 1000000 <br /> GENERALAGGREGATE $2000000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2000000 <br /> POLICY JECT LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000 <br /> F (Ea accident) <br /> A X ANY AUTO AU90696427 04/24/13 04/24/14 BODILY INJURY(Per person) $ <br /> ALL OWNED AUTOS <br /> BODILY INJURY(Per accident) $ <br /> F SC HEDULEDAUTOS PROPERTY DAMAGE <br /> � X ! HIRED AUTOS (Per accident) $ <br /> X NON-OWNED AUTOS $ _ <br /> $ <br /> UMBRELLA LIAB HOCCUR EACH OCCURRENCE $XXX <br /> LEXCESS UAB CLAIMS-MADE AGGREGATE $ <br /> DEDUCTIBLE $ <br /> RETENTION $ $WC STATU- H-A WORKERS COMPENSATION 22WBCCK0275 EXCLUDE TONY 06/24/13 06/24/14 X TORY LIMITS ER <br /> AND EMPLOYERS'LIABILITY <br /> ANY PROPRIETOR/PARTNER/EXECUTIVB�YIN WHITAKER,MICHAEL PIOCCOS E.L.EACH ACCIDENT $500000 <br /> OFFICER/MEMBER EXCLUDED? – NIA <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500000 <br /> KEITH GETTLE <br /> DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE <br /> ORANGE 6 THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Orange County <br /> 306 F Revere Road AUTHORIZED REPRESENTATIVE <br /> PO Box 8181 <br /> Hillsborough NC 27278 Sandy B. Fisher <br /> I <br /> ©1988-2009 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD <br />