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OP ID:C1 <br /> CERTIFICATE OF LIABILITY INSURANCE DATE(M �'Y) <br /> 10/233/20/20Y14 <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 CONTACT <br /> Lee-Moore Insurance Agency Inc NAME: <br /> P.O.BOX 667 PHONE FAX <br /> A/C No Ext: A/C No): <br /> West End,NC 27376 E-MAIL <br /> Christopher Stephenson ADDRESS: <br /> PRODUCER MDMHI-1 <br /> CUSTOMER ID#: <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURED MDM Historical Consultants,In INSURER A:Hartford Insurance 14397 <br /> Cynthia de Miranda INSURER B: <br /> PO Box 1399 <br /> Durham,NC 27705 INSURER C: <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 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 /> ILTR TYPE OF INSURANCE L POLICY NUMBER MIMIDDY/YYYY POLICY DD/YYYY LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 <br /> A X COMMERCIAL GENERAL LIABILITY X 22SBMVE4769 09/25/2014 0912512015 PREMISES Ea occurrence $ 800,00 <br /> CLAIMS-MADE El OCCUR MED EXP(Any one person) $ 10,00 <br /> PERSONAL&ADV INJURY $ 1,000,00 <br /> GENERAL AGGREGATE $ 2,000,00 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 <br /> POLICY PRO- LOC Emp Ben. $ 5,00 <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 100,00 <br /> (Ea accident) <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED AUTOS BODILY INJURY(Per accident) $ <br /> SCHEDULED AUTOS PROPERTY DAMAGE <br /> X HIRED AUTOS 22SBMVE4769 09125/2014 0912512015 (PER ACCIDENT) $ <br /> X NON-OWNED AUTOS 22SBMVE4769 09/2512014 09/2512015 L $ <br /> $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAR HCLAIMS-MADE AGGREGATE $ <br /> DEDUCTIBLE $ <br /> RETENTION $ $ <br /> WORKERS COMPENSATION STATU- OTH- <br /> AND EMPLOYERS'LIABILITY Y/N T WC RR LIMITS <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE <br /> OFFICERIMEMBER EXCLUDED? ❑ NIA <br /> E.L.EACH ACCIDENT $ <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 /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) <br /> Natural and Cultural Resources Division, Support Services Division <br /> 306A Revere Rd. <br /> Hillsborough, NC 27278 <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Natural and Cultural Resources THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Division,Support Services <br /> Division <br /> 306A Revere Rd. AUTHORIZED REPRESENTATIVE <br /> Hillsborough,NC 27278 Christopher Stephenson <br /> ©1988-2009 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD <br />