|
DocuSign Envelope ID: E5CFB54D-45A2-4A52-A7AO-8998D2AA66F6
<br /> - 0 1� .�,
<br /> 111 . ERTIFICAT OF LE ILITY IVSURAN� E 1 /30/2014
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT'S 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, ISSUING INSURER(S), AUTHORIZED
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the Ipolicy(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 N�MNM CT Beverly Pike, AAI
<br /> Jake A Parrott Insurance Agency Inc PHONE C 2)S23�-1041 axc Na lzsaasx cams
<br /> 2508 N HERRITAGE STREET A"0ApL .bpike@parrottins.com
<br /> PO BOX 3547 1!1Lt RE s AFFORDING COVERAGE .... _..... NAIC N
<br /> Rl_)... ....
<br /> KINSTON NC 28502 INSURERA EMPLOYERS MUTUAL CASUALTY CO 1415
<br /> INSURED INSURERB:EMASCO INSURANCE COMPANY 21407
<br /> TILE RESTORATION INC INSURER C;
<br /> _.__..........._._ _.........._. .... .........._._ _....._ .........
<br /> C/O ALBRITTON CO INSURER D:
<br /> PO :BOX 160 INSURER.E
<br /> t OOKERTON NC 28538-0160 1 INSURER IF:
<br /> COVERAGES CERTIFICATE NUMEIMCL14102908345 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 CONDITIION OF ANY CONTRACT OR OT'I4ER DOCUMENT WITH RESPECT TO "WHICH THIS
<br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICTS DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br /> EXCLUSIONS AND CONDITIONS OF SUCH POLUCIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> IN$k °°..- .-�_.__ ......... ......__._..._._m._.._.._.__ R- POLICY EFF POLICY EXP_ .__.
<br /> LTR TYPE of INSURANCE POLPCY NUMBER MMA1Dr7/YYYY MMItDD1YYYY LIMITS
<br /> GENERAL UARRUTY EACH CCCURRENCE $ 1,000,000
<br /> E'Fivl �T _....._
<br /> X COMrwr7L:FG<IM GENERAL UARIrNTY FREIV*ES IEgpggaeCS"aIL $ 500,000
<br /> p
<br /> rArS.MALF .. ._�OCCUR sr2DS46 11/7/2014 1/7/2015 A
<br /> VEDEM (ArymrtAperson) $ _ 1.0,0_00
<br /> ._........
<br /> Iyr RFtNAL.A¢ry INJURY _1,000„000'
<br /> aaEIaERALA,eTcw,REaATE 5 2,000,000
<br /> C'E t AGGREGATE UMIT APPUES PER PRODL CIS-COM.PIOR ACs(.,a $ 2,000,000
<br /> P LIcCv X I I I Ds-
<br /> AUTOMOBILE LIABILITY lM'OM81NE.D SIN(3LF LtlWT
<br /> 000
<br /> A ANY AUTO BOLI JI Y NNJURY IPer persorrl $
<br /> ALL OWNED ......� SCHEDULED SE20546 1/7/2414 1./7/2415 SODILY NNJUJRY IPeraacddent) $
<br /> AUTOS AUTOS
<br /> NLIN4.bNNEL PR Prf rrI';r aI C.E.... .............. ....._.,..m ..._...._
<br /> .._... HIRED AUTOS .,..............AUTOS' 1ELD.q.�t aLi u $
<br /> -1-Meth al n rnents _� .2 000
<br /> X UMBRELLA UAB OCCUR EACH OCCURRENCE $ ,000,000
<br /> EXCESS LIAB CLAIM$ManADE,' AC'C RE4 ATE $ 2,000,00 O
<br /> DED RLTENrroN$ 5,7220546 11f7/2tJ1.4 1J7J2a15 $
<br /> WORKERS COIMPENSA-I OIV X 'J'u`C 5'Pfe'fkJ , +CTtR
<br /> ANY PROPRUETOWFAR�NERrEXEC EXECUTIVE YIN
<br /> m�,., R$ 41546.. ',1/4f217."J.4. 11/d/2e15 8",.;tl_.:.G.A.HYPWCCn,"�ENT.. ...Ef3.�.� __..
<br /> AND EMPLOYERS'LIABILITY
<br /> OFRF-ER/MEPM8LR EXCLUDECi7 Y N1 ..._ I 0m00-1-000
<br /> (Mandatory in NH) E.L.LISP 5Em::..C:Am FIM PLOY E E $ 1 CS00,000
<br /> ..NIF SCRI e"esf QN under
<br /> F OPERA FUNS below_.._w..._._..''... .........____ ..... ..... ........._........... ....,_...,,_ .__....�,',. ___...... ..E':.L [Y0 rI�.ASE-POLICY LVIMIT !� 1,000,000�
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additlortal Remarks schedule,it rnore 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 /> CERTIFICATE HOLDER CANCELLATION
<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 2 7278 AUTHORIZED REPRESENTATIVE
<br /> Allen Parrott/"LEANFTU
<br /> ACORD 25(2010/05) On 1988;2010 ACORD CORPORATION. All rights reserved.
<br /> INSn7 a�,,nlr,Ifi+', nl Tho Arrtpn mama oral Ir nn area rank#marl mark.of Al'r(*)Pn
<br />
|