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DocuSign Envelope ID: FFA2C826-5690-4F42-8E6E-2ADOBE9BB131 <br /> OP ID: DJ ATE CERTIFICATE OF LIABILITY INSURANCE D01126/2015Y) <br /> 01/26/2015 <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 /> High&Rubish Insurance Agency PHONE IFAX <br /> P.O.Box 3040 A/c No Ext: A/c No): <br /> 6015 Farrington Rd.Ste 101 E-MAIL <br /> ADDRESS: <br /> Chapel Hill,NC 27517 PRODUCER pIEDM-3 <br /> High&Rubish CUSTOMER ID#: <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURED Piedmont Wildlife Center INSURER A:Auto-Owners Insurance 18988 <br /> 364 Leigh Farm Rd. INSURER B <br /> Durham, NC 27707 <br /> INSURER C: <br /> INSURER D: <br /> INSURER E: <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 /> INSR I TYPE OF INSURANCE ADDL SUB POLICY EFF POLICY EXP <br /> LTR INSR WV0 POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ <br /> COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED <br /> PREMISES Ea occurrence $ <br /> CLAIMS-MADE F—I OCCUR MED EXP(Any one person) $ <br /> PERSONAL&ADV INJURY $ <br /> GENERAL AGGREGATE $ <br /> GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ <br /> POLICY PRO- LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> ANY AUTO (Ea accident) <br /> ALL OWNED AUTOS BODILY INJURY(Per person) $ <br /> BODILY INJURY(Per accident) $ <br /> SCHEDULED AUTOS PROPERTY DAMAGE <br /> HIRED AUTOS (PER ACCIDENT) $ <br /> NON-OWNED AUTOS $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DEDUCTIBLE <br /> RETENTION $ $ <br /> WORKERS COMPENSATION WC STATU- OTH- <br /> AND EMPLOYERS'LIABILITY YIN X TORY LIMITS ER <br /> A ANY PROPRIETOR/PARTNER/EXECUTIVE 35041122 0310412014 0310412015 E.L.EACH ACCIDENT $ 500,000 <br /> OFFICER/MEMBER EXCLUDED? 1:1 NIA <br /> (Mandatory in NH) 35041122 03/0412015 0310412016 E.L.DISEASE-EA EMPLOYEE $ 500,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 <br /> 7 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> ORANG-3 <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 REPRESENTATIVE <br /> ©1988-2009 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD <br />