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09/13/2013 11:33 FAX Senn Dunn 100001/0001 <br /> BIRSI-2 OP ID:LE <br /> CERTIFICATE OF LIABILITY INSURANCE °AT091131YYYY' <br /> 09l13f13 <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($), 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 tents 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 336-272.7161 NA.E,ONTAUT L nne A Me er,CIC,CPIW,AINS <br /> Senn Dunn-GSO P"°'IN 336.346-13 <br /> 3625 N.Elm St. 336-346-1397 02 KC No;336-612.3818 <br /> P O Box 9375 A DE ;lmeyer@senndunn.com <br /> Greensboro,NC 27429-0375 <br /> David R.Clem,CIC INSURER(St AFFORDING COVERAGE NAIC s <br /> INSURER A:Continental Casualty Co. 20443 <br /> INSURED SIRS,Inc. INSURERB:Builders Mutual Ins.Co. 10844 <br /> Mr.Raven Brooker <br /> PO Box 36197 INSURER C:COIumbia CaSt,lalty Company 31127 <br /> Greensboro,NC 27416-6197 INSURER D: <br /> INSURER F: <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 TYPEOPINSURANCE POLICYNUMBER IDD/YYYY &IMIDD LIMITS <br /> GENERAL LIABILITY <br /> EACH OCCURRENCE $ 1,000,00 <br /> A NXX COMMERCIAL GENERAL LIABILITY 1071978219 06/01/13 06/01114 PREMISES Ea ooaEL) $ 100,00 <br /> CLAIMSiMOE X�OCCUR MED EXP(Any one person) S 5,00 <br /> PERSONAL SADVINJURY $ '1,000,00 <br /> G ENERALAGGREGATE $ 2,000,00 <br /> GEML AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOPAGG $ 2,000,00 <br /> POLICY X PRO' LOG 3 <br /> AUTOMOBILE LIABILITY COa81NEDI SINGLE LIMIT 1,000,000 <br /> A X ANY AUTO C1071978222 0510iM3 05101114 BODILY INJURY(Par perow) 4 <br /> UTO$ AUTOS BODILY BODILY INJURY(Per acddanl) 3 <br /> X HIRED AUTOS X NON-O rNED PROPERTY OAMA E $ <br /> AUTOS <br /> r m <br /> Comp/Coll s 1,000/1,00 <br /> 4 XX UMBRELLA LIAB <br /> OCCUR EACH OCCURRENCE $ 6,000,00 <br /> A EXCESS LIA6 I I CLAIMS�MADE 1071978253 06/01/13 05/01/14 AGGREGATE $ 5,000,00 <br /> DED I X I RETENTION 0 $ <br /> WORKERS COMPENSATION X V1C STATU• 0 T- <br /> AND EMPLOYERS'LUIBILITY YIN 1 <br /> B ANY PRoPRIETowARTNERIEXECUTIvE PWC100029002 05101113 05/01/14 E.L.EACH ACCIDENT $ 600,00 <br /> OFFICERIMEMBER EXCLUDED? N MIA <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 500,00 <br /> NyybeRIPTf0MOFO E.L.DISEASE-POLICY LIMIT $ 600,00 <br /> DES descION OF OPERATIONS below <br /> A Rental Equipment CID71978219 06/01/13 05101/14 Limit 100,00 <br /> C Professional Ltab CEOSSIS55996 05/01/13 06/01/14 Limit 31.000100 <br /> UESCRIPTION OF OPERATIONS I LOCA'nONS/VEHICLES(Attach ACORD 101,Additional Re narks Schedule,If mrs space Is roquirod) <br /> CERTIFICATE HOLDER CANCELLATION <br /> ORANINS <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE: THEREOF, NOTICE WILL BE DELIVERED IN <br /> Orange County ACCORDANCE WITH THE POLICY PROVISIONS. <br /> PO Box 8181 <br /> Hillsborough,NC 27278 AUTNOR¢EOREPRESENTATIVE <br /> 00.1 /? a', <br /> ®1886.2010 ACORO CORPORATION. All rights reserved. <br /> ACORD 26(2010105) The ACORD name and logo are registered marks of ACORD <br />