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DocuSign Envelope ID: 3312F4DA-F50C-44DA-9298-271ABA823577
<br /> ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE(MM1DDrYYYY)
<br /> 7/1/2015 9'/11/2014
<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 AF'FORD'ED 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(les)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 /> CONTACT
<br /> PRODUCER LCICKTON COMPANIES
<br /> 2100 ROSS AVENUE,SUITE 1400 ('AM IL,Ext; JAdC No):
<br /> DALLAS TX 75201 EMAIL
<br /> 214-9691-6700 ADDRESS:
<br /> AFFORDING COVERAGE
<br /> INSURER A: Federal Insurance Company 20281
<br /> INSURED Door Services Corporation INSURER B, Iromhore Specialty Insuranee Co 25445
<br /> 1342188 tlba Advanced Door AUtomatlon INSURER C: Mitsui Sumitomo Insurance Co of Arnerien 2 I)3t2
<br /> PO Sox 61678 i"
<br /> Durham NO 27715 UgEg 0; Chubb lndernnity Insurance C tacit art 12777
<br /> INSURER E:
<br /> COVERAGES C VEQ00I CERTIFICATE NUMBER: 12357291 REVISION NUMBER: XXXXXXX
<br /> IHIS IS'°O CERTIFY THAT THE POLICIES OF INSURANCE L16TED BELOW HAVE BEEN ISSUED'TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br /> IINDICATED. 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 /> IN SR TYPE OF INSURANCE AdDL SUBR POLICY NUMBER P4��1CY EFF POLICY EXP LIMITS
<br /> X COMMERCIAL GENERAL LIABILITY NI N (.3-.2122489' 1.0/l/2014 10/i/2015 EACH OCCURRENCE 2,000,000
<br /> CLAIMS-MADE OCCUR
<br /> DA MA E TIC"RENTED �X10 ���
<br /> PREMISE Ea accurrence $ 1,appligs per MED EXP(Any one Person) $ 1.0',00 ...._
<br /> policy'terms&sand. PERSONAL&ADV INJURY 's 2,000 000
<br /> 'L AGGREGATE AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 4,000,000
<br /> POLICY' PECOT» ❑LOC PRODUCT"S-COMPdOP AGG S 41000-000
<br /> OTHER $
<br /> A AUTOMOBILE LIABILITY N N 73570693 10/1/201.4 1011/2015 =tsiNGLELIMIT $ 1 00()()00
<br /> X ANY AUTO BODILY INJURY(Per person) $ XXXXXXX
<br /> ALLI,S'W'NED MSCHEDULED AT BODILY INJURY IPer accident $ XX XXXX
<br /> 1177 NON OWNED PRDPERTY DAMAGE $ XX�tdCXXX
<br /> X HIRED AUTOS AUTOS a ld nt
<br /> $ XXXXXXX
<br /> 13 X UMBRELLA LIAB I'X OCCUR 1`'+1 N 00 1165 903 10/1/2014 1011.1201.5 EACH OCCURRENCE $ 101000110100
<br /> EXCESS LIAR CLAIMS-MADE AGGREGATE $ 10„0'00 00'0
<br /> DEC),I X, RETE.NITIONS'I(),ufJO 10TH $ XXXXXXX
<br /> WORKERS COMPENSATION
<br /> PER
<br /> A AND EMPLOYERS LIABILITY 71740£3 t4tAiJS,i ICI/112CiY4 Ii5Pi12111S X STATUTE _
<br /> Cl �I NIA 71747712(MA,W1) ICI/1/2014 10/1/2015
<br /> � 1 0t70�0r�q.....
<br /> A"�'Y PRr,3PRET ERFEXCLNEV�"EkCECII ruv'E E L EACH ACCIDENT
<br /> Or"A=�OERtAM1EMaEld E7tCLLNC�Ep"$ ➢Y
<br /> 7 ridntory in NHI E..L.DISEASE EA EMPLOYEE $ 1,000,000
<br /> . �.�
<br /> It Ye s,dt�sx lbe un�dnr
<br /> OE5'C,R IP"&ON OF OPERATIONS cec o. E.L.IDMLASE.POLICY LIMIT 1,000,000
<br /> A T:wucs,Wwko, 1N N 7174 7 695(0111 7/112171.4 711/2015 WC 5tutta u"Limut,
<br /> "q,am ix IesuMUnra(t7IEi S
<br /> 1,000,060 t.L,rE ach,Accidoil
<br /> E I,MA),000 EI Dlsosc iir¢°Ile!I'aaGc r
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES(Attach ACORD 101,Additional Remarks ScheduW,may be attached if more space is required)
<br /> RE:John Link Government Services Center,Raleigh,NC.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE P'O'LICY PROVISIONS.
<br /> 12357291 AUTHORIZED REPRESENTATIVE
<br /> Gran e County Asset Management Services'
<br /> 200 South Cameron Street
<br /> Hillsborough NC 27278
<br /> ACORD 25(2014101) @1988-2014 ACORD CORPORATION.All rights reserved
<br /> The ACORD name and logo are registered malrks of ACORD
<br />
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