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DocuSign Envelope ID:4C996037-012A-4978-866D-FBEA2FO2CC51 <br /> CARR-01 OP ID: C1 <br /> CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDD/YYYY) <br /> 04/27/2015 <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 /> The Insurance Center of Durham NAME: Philips,Wolf <br /> ON o 919-471-2541 FAX Front St„Suite 710 NC E • o No):919 32 <br /> P. 16369 DRIE <br /> Durh am,NIC 27 704- <br /> aSS;Phil@!nsurancecenterofdurham.com <br /> Philip S.Wolf INSURER(SY AFFORDING COVERAGE NAIL N <br /> INSURERA:Auto-Owners Insurance Co. 18988 <br /> INSURED Robert W.Carr,Inc/ INSURER 13:Riverport Ins Co <br /> Associated Architects INSURER C:HISCOX <br /> Edgar Carr <br /> P O Box 1692 INSURER D: <br /> Durham,NC 27702 INSURERS: <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 /> POLICY NUMBER MMIDDlYEYYY MMIDDY <br /> INR TYPE OF INSURANCE AD LIMITS INSD <br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 <br /> CLAIMS-MADE a OCCUR X 5033393400 04/22/2015 04/22/2016 DAMAGETORE TEO <br /> PREMISES(Ea occurrence $ 300,00 <br /> MED EXP(Any one person) $ 10,00 <br /> PERSONAL&ADV INJURY $ 1,000,00 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 <br /> POLICY❑PRO F—]JECT LOG PRODUCTS-COMP/OPAGG $ 2,000,00 <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY Ea a8cideDtSINGLE LIMIT $ 1,000,00 <br /> A ANYAUTO X 50333934-00 04/22/2015 04/22/2016 BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED U <br /> INJ <br /> L <br /> O INJURY BODILY Peraccident <br /> AUTOS AUTOS ( ) $ <br /> NOWOWNED PROPE <br /> X HIRED AUTOS RTY DAMAGE $ <br /> AUTOS Par accident <br /> $ <br /> UMBRELLA LIAR OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DEO RETENTION$ $ j <br /> WORKERS COMPENSATION X STA UTE ER H <br /> AND EMPLOYERS'LIABILITY <br /> B ANY PROPRIETORIPARTNERIEXECUTIVE YIN BOUND 04/22/2015 04/22/2016 E.L.EACH ACCIDENT $ 100,00 <br /> OFFICERIMEM13EREXCLUDED? NIA <br /> (Mandatory in NH) E,L.DISEASE-EA EMPLOYEE $ 100,00 <br /> If es,describe ender <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 <br /> C PROFESSIONAL LIAB UDC-15 7196BEO-15 04/22/2015 04/22/2016 EACH LOSS 1,000,00 <br /> AGGREGATE 1,000,00 <br /> 1 <br /> i <br /> DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Scheduls,may be attached It more space Is requlred) <br /> t <br /> f <br /> S <br /> CERTIFICATE HOLDER CANCELLATION <br /> ORAN016 <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 /> P O Box 8181 <br /> Hillsborough,NC 27278 AUTHORIZED RBPRESUNT' n E <br /> Philip S.Wolf f <br /> ©1988-2014 ACOIQD CORPORATION, All 1 hts reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br />