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DocuSign Envelope ID: CEA337F8-OE35-4358-A2A1-92E1B360044E <br /> 5THWA-1 OP ID: LJ <br /> CERTIFICATE OF LIABILITY INSURANCE <br /> DATE 02/07/2014Y) <br /> 02/07/2014 <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 Phone:919-556-3698 CONTACT <br /> Hartsfield&Nash Agency,Inc. NAME` <br /> Post Office Box 1109 Fax:919-556-8758 q/CNNo Ext: A/C No <br /> Wake Forest,NC 27588 E-MAIL <br /> Lorie Borrelli,CIC,AAI ADDRESS: <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURERA:Hartford Casualty Ins Co. 29424 <br /> INSURED 5th Wall Building Diagnostics INSURER B:Lexington Insurance Co. 19437 <br /> Consultants LLC <br /> 9601 Bailywick Rd INSURERC: <br /> Raleigh,INC 27615 INSURERD: <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 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 /> ILTRR TYPE OF INSURANCE DD BR POLICY NUMBER MM/DDY� MMIDDY EXP LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 <br /> A X COMMERCIAL GENERAL LIABILITY 22SBAVF0089 12101/2013 12/01/2014 D GE TO RE TED <br /> PREMISES Ea occurrence $ 300,000 <br /> CLAIMS-MADE 1XI OCCUR MED EXP(Any one person) $ 10,00 <br /> PERSONAL&ADV INJURY $ 2,000,00 <br /> GENERAL AGGREGATE $ 4,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 4,000,000 <br /> POLICY PRO—1 LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> Ea accident $ 2,000,000 <br /> A ANY AUTO 22SBAVF0089 12/01/2013 12/01/2014 BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident $ <br /> AUTOS AUTOS ) <br /> X HIRED AUTOS X NONAWNED PROPERTY DAMAGE $ <br /> AUTOS Per accident <br /> UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ 1,000,00 <br /> A EXCESS LIAB CLAIMS-MADE 22SBAVF0089 12101/2013 12/0112014 AGGREGATE $ <br /> DED I X I RETENTION$ $ <br /> WORKERS COMPENSATION VoC STATU- OT'_ <br /> AND EMPLOYERS'LIABILITY Y/N TORY LIMI S ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? ❑ N/A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> B Professional 43926702 02/12/2013 02/1212014 ea occ 1,000,000 <br /> Liability aggregate 1,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) <br /> RE:Window Condition Assessment Southern Human Services Chapel Hill, NC <br /> CERTIFICATE HOLDER CANCELLATION <br /> ORAN818 <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Or Box County WITH THE POLICY PROVISIONS. <br /> Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE <br /> L6A,?�vz' - `-' <br /> ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD <br />