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DocuSign Envelope ID: F4B3E08B-D87A-4AE0-BD19-D169D4E8F41B 5THWA-11 OP ID:AJ
<br /> AIIC"R"� DATE(MMIDDIYYYY)
<br /> CERTIFICATE OF LIABILITY INSURANCE P02/2312015
<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 CNTACT
<br /> NAOME� Anna Jane Coltrain
<br /> Hartsfi!eld&Nash Agency,Inc, P-NO N-E ........... 1-1-1 F A I X I
<br /> Post Office Box 1109
<br /> Wake Forest, NC 27588 E MAIL
<br /> XZDRESS�anina@t;�rtsfield-nash.com
<br /> Lorie Borrelli,CIC,AAI ...
<br /> INSURER A�Hartford Casualty Ins Co. 19424
<br /> .............
<br /> INSURED 5th Wall Building Diagnostics INSURER a:Lexington Insurance Co. 119437
<br /> ..........................
<br /> Consultants, LLC
<br /> 9601 Bailywick Rd .............................
<br /> Raleigh, INC 27615
<br /> I INSURER S:
<br /> INSURER ER 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 /> ..........................................._-ADOL
<br /> I suak-""', PodcY EyF P
<br /> LTR TYPE OF IN,SURANCE �WVD POLICY NUMBER [IMMIDDryyyy) IMMIDDNYYYL1 L.IMITS,
<br /> GENERAL LIABtLr"
<br /> EACH OCCURRENCE 2,000,00C
<br /> A X COMMERCIAL GENERAL LIABILITY 22SBAVF0089 121011120114 1210112015 ATMs G�Tff RENTEU 300,00C
<br /> CLAIM SMADE X OCCUR MED EXP(Any vre pprs,�,nS� 10,00(
<br /> JTF�9NAL AD� 2,000,00(
<br /> 4,000,00(
<br /> GF NERAL_AGGRFGAT.E 3___........
<br /> Q`�EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS COMPIOP AGG Is, 4,000,00
<br /> PRO. 1 s
<br /> �
<br /> POLICY I , L�_110r, �
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE,LAMIT
<br /> 2,0010,000
<br /> A ANY AUTO 22SBAVF0089 1210112014 1210112015 BODILY INJURY(Per perswI, Is
<br /> ALL OWNED I SCHEDULED BODILY INJURY IPer accxdwit0
<br /> AUTas AUTOS
<br /> NON-OWNED PAbPFAfY'rJA"IMAG'E�
<br /> HIREIDAUTOS LX11"!AUTOS PkNTJ___ $
<br /> UMBRELLALIAB OCCUR EACH OCCURRENCE is 1,000,000
<br /> A EXCESS LIAO CLAIMS-MADE 22SBAVF0089 1210112014 1210112015) AGGREGATE
<br /> I-OED x
<br /> � ` R E TE N I'l ON S
<br /> F AWAD EMPLOYERS'LIA RILrTY YrN A OfCE NIA E L EACH ACCIDENT �s
<br /> ..............
<br /> lMandatpoty ir,NH) E L DISEASE EA EMPLOYEE &
<br /> If d!escr�be undee
<br /> D. ()NS berow Y LIMIT $
<br /> CRiPTION OF.OPERATI f E L DISEASE-POLIC
<br /> S Professional
<br /> �43926702 0211212014 02112!2015!Occur 1,000,000
<br /> Liability !Aggregate 1,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS t VEHICLES (Attach ACORD 101,Adftonaf Remarks Scheduie,If More space Is requIred)
<br /> RE:Cates Farmhouse ; Blackwood Farmhouse
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> ORAN81 8
<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 AUTHORIZED REPRESENTATIVE
<br /> OL 1988-2010 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD
<br />
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