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DocuSign Envelope ID:OA6FEBA7-7CB5-4523-A4D2-2089COOE5340 <br /> Aco® CERTIFICATE OF LIABILITY INSURANCE 0610912IDDIYYYY) <br /> �. 06!09!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 /> NAME: <br /> BB&T INSURANCE SERVICES INC pA No Ext: 888 661-3938 A1C,Nn: 888 872-8921 <br /> 414 GALLIMORE DAIRY RD STE F E-MAIL <br /> GREENSBORO, NC 27409 ADDRESS:Serviee.eehte ravelere.com <br /> (888)661-3938 INSURER(S)AFFORDING COVERAGE NAIC N <br /> INSURER A:FARMINGTON CASUALTY COMPANY <br /> INSURED INSURER B: <br /> INFORMATION INC INSURER G: <br /> PO BOX 1306 <br /> CARRBO RO, NC 27510 INSURER D: <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 736973104531061 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 /> INSR ADDL SUBR POLICY EFF POLICYEXP <br /> LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDD)YYYY MMIDDIYYYY LIMITS <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ <br /> DAMAGE T RENTED <br /> CLAIMS-MADE OCCUR PREMISES Ea occurrence $ <br /> MED EXP(Anyone person) $ <br /> PERSONAL&ADV INJURY $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ <br /> POLICY PRO- <br /> JECT LOC PRODUCTS-COMPIOPAGG $ <br /> OTHER: <br /> $ <br /> AUTOMOBILE LIABILITY (Eaa acccidEent)INGLE LIMIT $ <br /> ANY AUTO BODILY INJURY(Par person) $ <br /> ALL OWNED SCHEDULED <br /> AUTOS <br /> AUTOS BODILY INJURY(Per accident) $ <br /> HIRED AUTOS NON-OWNED <br /> AUTOS PROPERTY DAMAGE <br /> (Per acoidant) $ <br /> S <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE S <br /> EXCESS LIAB CLAIMS-MADE $ <br /> AGGREGATE <br /> DED RETENTION$ <br /> A WORKERS COMPENSATION N!A UB-OF330489-14 08!27!2014 08!2712015 X SER RITE ORTH- <br /> AND EMPLOYERS'LIABILITY VN <br /> ANY PROPRIETORlPARTNERIEXECUTIVE ❑ E.L.EACH ACCIDENT I$1001000 <br /> OFFICERIMEMBER EXCLUDED? <br /> IMandatory in NH) E.L.DISEASE-EA EMPLOYEE $100,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> ORANGE COUNTY DSS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> 113 MAYO STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> HILLSBORO. NC 27278 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE ( <br /> ©1988-2014 ACORD CORPORATION.All rights reserved. <br /> ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />