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DocuSign Envelope ID:OA6FEBA7-7CB5-4523-A4D2-2089COOE5340 <br /> DATE(MIvL'DD+YYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE 6 2015 <br /> THIS CERTIFICATEIS 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(iies)must be endorsed. If SUBROGATIONIS WAIVED,subject to the <br /> 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 /> NAME' <br /> BB&'I INSURANCE SERVICES INC/PHS (MC,, NN,Exq: (866) 467-8730 fwc,No,: (877) 538-5295 <br /> 272545 P: (866) 467-8730 F: (877) 538-5295 ADDRESS: <br /> PO BOX 29611 INSURER(S)AFFORDING C.OVERAGE NAIL# <br /> CHARLOTTE NC 28229 INSURERA Hart ford CasialLy Ins Cz) <br /> INSURED INSURER 13: <br /> INSURER C <br /> INFORMATION INC INSURER <br /> PO BOX 1306 INSURER E <br /> CARRBORO NC 27,510 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 <br /> TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> FASR ADDL SUBR POLICY EFF POLICYEXP <br /> LTR TYPE OF INSURANCE �, POLICYNL',1gBER 0d111DD1YYY LIMITS <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1, 0 0 0, 0 0 0 <br /> DAMAGE TO RENTED 300, 0 0 0 <br /> CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) <br /> A X General Liab 22 SBM RL1951 11/30/2014 11/30/20-5 MED EXP(Any me person) 10, 000 <br /> PERSONAL&ADV INJURY ' 000, 000 <br /> GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE 2, 000, 000 <br /> JECT POLICY[7 PRO LOC PRODUCTS-COMPlOP AGG 2/ 000, 0 0 0 <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT(Ea accident) $1, 0 0 0, 0 0 0 <br /> ANY AUTO BODILY INJURY(Per person) g <br /> A ALL OWNED SCHEDULED 22 SBM 811951 11/30/20_4 _1/30/2015 BODILY INJURY(Per accidsni) $ <br /> AUTOS AUTOS <br /> X HIREDAUTOS X NON-OWNED PROPERTY DAMAGE 5 <br /> AUTOS (Per accidenl) <br /> s <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE <br /> DE RETENTION$ <br /> WORKERS C]OMPE,VSATION PER OTH- <br /> ANDEMPLOfERS'LLIRILlTY STATUTE ER <br /> ANY PROPRIETORIPARTNERIEXECUTIVE YIN E.L.EACH ACCIDENT 5 <br /> OFFICERIMEMBER EXCLUDED? ❑ N/A <br /> (Mandatory In NHI E.L.DISEASE-EA EMPLOYEE s <br /> If yes,describe under 5 <br /> E.L-DISEASE-POLICY LIMIT <br /> DESCRIPTION OF OPERATIONS below <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 161,Additional Remarks Schedule,may be attached If more space is required) <br /> Those usual to the Insured' s Operations . <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED <br /> BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE <br /> DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Orange County DSS AUTHORIZED REPRESENTATIVE 4 <br /> 113 MAYO STCc'� ���,�� <br /> HILLSBOROUGH, NC 27278 <br /> ©1988-2014 ACORD CORPORATION.All rights reserved. <br /> ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD <br />