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DocuSign Envelope ID: DCCF8247-909F-423A-AB78-8E598OB981EE <br /> DATE{hTMfDD/YYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE <br /> PRODUCER THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION <br /> Maguire Imufance Agency,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> 27101 Puetta Real suite 200 HOLDER. THIS CERTIFICATE DOES NOT AMMEND, EXTEND OR <br /> Mission Viejo,CA 92691. <br /> 877A38.7459 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> INSURERS AFFORDING COVERAGE NAIC 11 <br /> INSURED INSURERA:Ph'We!pha Inderrun ty Insurance Company 18058 <br /> SteVe Kim INSURER FI: <br /> dba:US Tae Kw❑n 00 Center,Inc. INSURER C: <br /> 4416 Sun Varay Of <br /> Durham,NC 277075684 INSURER D: <br /> INSURER E: <br /> COVERAGES <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br /> ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERIFICATION MAY BE ISSUED OR <br /> MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH <br /> POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR ACD'L I POLICY EFFECTIVE POLICY EXPIRATION <br /> LTR INSRD TYPE OF INSURANCE POUCYNUM6FR _DATE[MNVOD/YYYY) DATE(MM/DD/Y"Y) LIMITS <br /> A X GENERAL LIABILITY p8p)(519280-004 03/051ZOt4 03/05/2015 EACH OCCURIENCE $1,000,000 <br /> CO""" """"NERALLIABRITY PREMISES(Eaciccurm cc) 106060 <br /> MADE OCCUR MEO W(Any one person) $2,500 <br /> ABILITY P E ASON At&ADV DO U BY $1,000,000 <br /> 6 f N C 8 At AGGREGATE $3,000,000 <br /> GENT AGGREGATE U M IT APPLIES PER: P RO DUCTS—CO?,IP/0 P AG G $3,000,000 <br /> r—X] POLICY Ll PROJECT F-1 Lot: <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> ANYAUTO (EA a CC dent) <br /> ALL OWNED AUTOS BODILY INIURY <br /> SCHEDULED AUTOS (Pet person) <br /> H18tO AUTOS BODILY INJURY <br /> NON-OWNED AUTOS (PeraccIdent) <br /> PROPERTY DAMAGE <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY—CA ACCIDENT <br /> —1 ANYAUTO OTHER THAN EA ACC <br /> AUTOONLY: AGG <br /> EXCESS/UMBRELLA LIABILITY EACH OCCURENCE <br /> OCCUR E CLAIMS MADE AGGREGATE <br /> HDEDUCTIBLE <br /> RETENTION <br /> WORKERSC MPENSA]IONAND wc7ITTL.T---r--TQTH- <br /> EMPLOYERS'L[ABILtTY WEE Tokyumn-S I I ER <br /> ANY PROPRIETOR/PARTNE EXECUTIVE <br /> OFFICWMEMSER EXCLUDN E.L.EACH ACCIDENT <br /> (Mandatory in NH) E1-DISEASE—EA A"PLOYEE <br /> if Yes(AdI.ec pR'6VIS!ONSbe <br /> s ibe under <br /> r*w E.L.DISEASE—POLICY LIMIT <br /> SPEC <br /> OTHER <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENOCIPAWEN1 it SPECIAL PROVISIONS <br /> It Is understood and agreed that the f0ow:ng entity is added as an additloasil insured but only w4h respectis)to the operations of the named Insured except that tabi!ity resulting from the additional Insured's We <br /> negi,gente. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOVED ANY Of THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE <br /> Orange Co.n1yAtW Risk Management THEREOF, THE ISSUING INSURER %VIU. ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE <br /> 2005 Cameron St,PO 8-8181 CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR <br /> Hilisliwough,NC 27278- LIABILITY OF ANY XINR UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES, <br /> AUTHORIZED REPRESENTATIVE <br /> (10 <br /> ACORD 25(2009/01) 0 1988-2009 ACORD CORPORATION.All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />