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DocuSign Envelope ID:8BDA6ABE-28AD-4D4C-AE17-79316DFF4221 5THWA-1 OP ll[) AJ
<br /> CRTIFICATE, OF LIABILITY INSURANCE DA7F fMM1DDr(YYY)
<br /> E
<br /> r 02/2312015
<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 /> IMIPORTANT. 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 C.-A.. TEA CT
<br /> Anna Jane Colrain
<br /> Hartsfield &Nash Agency,Inc. P H ONE.. .
<br /> —1--1--rr F-A I X 1-11'r-11-1-r-r-r-r-
<br /> Post Office,Box 1109
<br /> Wake Forest,NC 27588 E�MAIL
<br /> ADDRE,ss anna@.hartsfield-nash.com
<br /> Lorie Borrelli,CIC,AAI
<br /> .. ............I-N§L1R.E!y§J_LFF
<br /> INSURER A:Hartford-Casualty Ins Co. �29424
<br /> -- ------------------ .................
<br /> INSURED 5th Wall Building Diagnostics INSURER a:Lexingtqn Insurance Co. 19437
<br /> Consultants,LLC .. .. . -1 -.1-1—.11, ----- -I � - -,"", ,,- 1. --11 --I
<br /> 9601 Efailywick R!d
<br /> Raleigh, NC 27615 ............. .............
<br /> INSYRE.R-E L ..... ......
<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 NOrWITHSTANDING 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 /> ...........................
<br /> pOL
<br /> TYPE OF INSURANCE POLICY NUMBER MIDDNYyn LIMRS
<br /> LTR I , (M I M",4p I
<br /> GENERAL LIABILITY EACH OCCURRENCE S 2,000,000
<br /> -DAMA69 rORENTED
<br /> A X COMMERCIAL GENERAL LIABILITY 22SBAVF0089 1210112014 12101/2016 ",5
<br /> PREMI - 300,00 11 CLAIMS DoE X MED Ex P(Any one person) 10,00
<br /> OCCUR
<br /> 'PER,S,ONAL&-A-D-V INJURY -s-
<br /> 4,000,001
<br /> ENERAL AGGREGAT
<br /> AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGO S 4,000,600
<br /> POLICY LOD
<br /> AUTOMOBILE LIABILITY
<br /> I ANY AUTO
<br /> A 22SBAVF0089 1210112014 12/01/2016 BODILY INJURY JP&person) [5
<br /> -[—s ---
<br /> ALL OWNED All rOS SCHEDULED
<br /> AUTOS BODILY INJURY gPet
<br /> acodenl)
<br /> X NON-OWNED PROPERTY DAMAGE—
<br /> HIRED AUTOS AUTOS S
<br /> UMBRELLA LIAB mm I OCCUR EACP I,OCCURRENCE S 1,000,00C'-,,,,-
<br /> A EXCESS UAB CLAIMS-MADE �22SBAVF0089 12101112014 1210112D15 AGGREGATE
<br /> DED X RETENTIONS
<br /> YVORKERS COMPENSATION I WC STATU'- OTir I-
<br /> AND EMPLOYERV LIABILITY I.QRA-Umila. ---F.9—a --
<br /> A YPROPP10ORIPARINERPEXE E I. EACH ACCIDENT
<br /> N X
<br /> OFFICERNEMSER EXCLUDEW INIA�l
<br /> (MandA"in NHI E I. DISEASE-EA EMPLOYEE�
<br /> Ut, -- m.,.,._..,
<br /> ps,dev.76c wider
<br /> SCRIPTiON OF OPERATIONS b0ow i El DISEASE-POLICY LIMIT 1 S
<br /> B (Professional 43926702 02121204 02/1212015 �Occur 1,410
<br /> 0,80
<br /> 0100,110
<br /> Liability 1,00
<br /> Aggregate
<br /> DESCRIPTION OF OPERAInONS I LOCATIONS I VEHICLES (A"ach ACORD 101,Additional Remarks Schedule,iif more space is raqt&vd)
<br /> RE:Cates Farmhouse ; Blackwood Farmhouse
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> ORAN818
<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 AUIHORIZE0 REPRESENTATIVE
<br /> Q 1988.21010 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD
<br />
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