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DocuSign Envelope ID: 531A624F -5F3E- 4968- AE71- AC91280DFFCE <br />ACORO® CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MMIDD /YYYY) <br />10/30/2014 <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 <br />Jake A Parrott Insurance Agency Inc <br />2508 N HERRITAGE STREET <br />PO BOX 3547 <br />KINSTON NC 28502 <br />CONTACT Beverly Pike, AAI <br />PHONE (252) 523 -1041 FAA/C No: (252)523 -0195 <br />E -MAIL <br />ADDRESS: b P ike @parrottins.com <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSURERA:EMPLOYERS MUTUAL CASUALTY CO <br />21415 <br />INSURED <br />TILE RESTORATION INC <br />C/O ALBRITTON CO <br />PO BOX 160 <br />HOOKERTON NC 28538 -0160 <br />INSURERB:EMASCO INSURANCE COMPANY <br />21407 <br />INSURERC: <br />INSURER D: <br />INSURER E : <br />$ 1,000,000 <br />INSURERF: <br />X COMMERCIAL GENERAL LIABILITY <br />COVERAGES CERTIFICATE NUMBER:CL14102908345 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 REDU CED BY PAID CLAIMS. <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />5 <br />SUER <br />D <br />POLICY NUMBER <br />POLICY EFF <br />MM /DD/YYYY <br />POLICY EXP <br />MM /DD/YYYY <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1,000,000 <br />X COMMERCIAL GENERAL LIABILITY <br />DA AGE <br />PR M SESOEa occu RENTED nce <br />$ 500,000 <br />A <br />CLAIMS -MADE ❑X OCCUR <br />5D20546 <br />11/7/2014 <br />11/7/2015 <br />MED EXP (Any one person) <br />$ 10,000 <br />PERSONAL & ADV INJURY <br />$ 1,000,000 <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGG <br />$ 2,000,000 <br />$ <br />POLICY X PRO- LOC <br />AUTOMOBILE LIABILITY <br />EOMa6c1 aBDiSINGLE LIMIT <br />$ 1,000,000 <br />BODILY INJURY (Per person) <br />$ <br />A <br />X ANY AUTO <br />ALLOWNED SCHEDULED <br />AUTOS AUTOS <br />E20546 <br />11/7/2014 <br />11/7/2015 <br />BODILY INJURY (Per accident) <br />$ <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />HIRED AUTOS NON -OWNED <br />AUTOS <br />Medical payments <br />$ 2,000 <br />X <br />UMBRELLA LIAB <br />HCLAIMS-MADE <br />OCCUR <br />EACH OCCURRENCE <br />$ 2,000,000 <br />AGGREGATE <br />$ 2,000,000 <br />A <br />EXCESS LIAB <br />DED I I RETENTION$ C <br />$ <br />J20546 <br />11/7/2014 <br />11/7/2015 <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N <br />OFFICERlMEMBEREXCLUDED? Y <br />(Mandatory in NH) <br />N/A <br />5H2O596 <br />1/4/2019 <br />11/9/2015 <br />X WCORY LIMIT- X OTH- <br />FR <br />E.L. EACH ACCIDENT <br />$ 1 000,000 <br />E.L. DISEASE - EA EMPLOYE <br />$ 1 000 000 <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$ 1,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />CERTIFICATE HOLDER IS LISTED AS AN ADDITIONAL INSURED AS PERTAINS TO GENERAL LIABILITY, ON A PRIMARY <br />BASIS INCLUDING PRODUCTS & COMPLETED OPERATIONS, VIA A WRITTEN CONTRACT IN PLACE WITH THIS REQUIREMENT <br />INCLUDED. CERTIFICATE HOLDER IS LISTED AS AN ADDITIONAL INSURED AS PERTAINS TO AUTO LIABILITY, VIA A <br />WRITTEN CONTRACT IN PLACE WITH THIS REQUIREMENT INCLUDED. WAIVER OF SUBROGATION IN FAVOR OF ADDITIONAL <br />INSURED APPLIES TO GENERAL AND AUTO LIABILITY AND WORKER'S COMPENSATION, VIA A WRITTEN CONTRACT IN PLACE <br />WITH THIS REQUIREMENT INCLUDED. <br />EXCLUDED OFFICERS IN WORKER'S COMPENSATION COVERAGE: DAVID ALBRITTON & CHARLES ALBRITTON III. <br />l;tK 1 II-IUA I t <br />ORANGE COUNTY <br />PO BOX 8181 <br />HILLSBOROUGH, NC 27278 <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 />AUTHORIZED REPRESENTATIVE <br />Parrott /LEANNE <br />ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. <br />INS025(9Mno.9) m Thn Ar OPr) namc and Innn mrc rcnicfcrnrl mnrlrc of ARr1R11 <br />