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DocuSign Envelope ID:857F34A8-1AB5-4307-B533-32F8EA1758FC
<br /> Ac"R" CERTIFICATE OF LIABILITY INSU�RANCE
<br /> DATE IMMJDWYYYYI
<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 INOT 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 NAME;CONTACT Steven Stacy
<br /> Pelnik Insurance PHONE. (919)459-8000 (AC,NP)._(919)455 60le
<br /> .IA,I.G,Nw.Eastd,
<br /> 1.04 Ridgeview Drive LAPP- EI'&ateve.StacyLPe11nik.com Ir
<br /> Suite 100 INSURER{S),AFFORoNG COVERAGE .. NAIL#
<br /> Cary ETC 27511 INSURERA:Selective Insurance
<br /> INSURED '..INSURERB:Suilders Mutual Insurance Co 10844
<br /> Intellicom Ina, INSURER c.
<br /> 2902 S Miami Blvd Ste C I INSURER D:
<br /> INSURER E
<br /> Durham Nc 27703 INSURER
<br /> COVERAGES CERTIFICATE NUMBER:CLI54112016 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. NOTWV'fTHSTANDING ANY REQUIREMENT,TERM OR CONDITOON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TD WHICH THIS
<br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE IN. URANCE 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 _TYPE OF INSURANCE. ... _...._"AOOL 5U8'It POLICYE FF ..iiducY E%P LIMITS
<br /> LTR POLICY NUMBER MMJDDIYYYY MMPDDIYYYY
<br /> ',Y, COMMERCIAL GEN.ERALLIABILITY
<br /> EACICOCCURRENCE .._.. S . I Q..QQ 000
<br /> OAAUE T6P'5NTEC .
<br /> A CLAIMS-MADE X (O4"!G:UR 100,QQQ
<br /> S 2162397 +5/1,/201.5 Adi/2.016 �IAED FKF IAray arTe Lzur�zanp., S ... 10,000
<br /> PERSONAL S A,Dv INJ,LRY_ „S 1,000,000
<br /> L,"EN&.AGOREOATE L,IhAiT APf"I_VES PER:
<br /> GFNERd.AGGREGATE t .3,000,000
<br /> ..X P fl:N..IC'W ... _.
<br /> Fril4a- 3,000,000 I
<br /> - JFC.:T ,. . . ... GO a
<br /> L.L1C I PRA",YEdUG OLIMF4L.DR'A .......,_. .. .,
<br /> OTIRER,, I Employee€Sened`¢1r� �...
<br /> !COMBINED SINGLE LIMIT'
<br /> AUTOMOBILE LIABILITY I 5 1,000,000
<br /> ALL 6'b'WNE0 SCHEDULED ED � 7 I +5 1 2015 4/1/2016 BODIL INJURY(Pa.r arcac'w t...'�....A INJURY Per erson $
<br /> AUTOS AUTOS S 275239 d / I
<br /> NL?N-OIMNE.C,1 PROPERTY L7••AMYFtC:E.
<br /> I-fIREO AUTOS L_,.Y.`.. AUTOS i QPrar.rrrdchevJiL..... .........—
<br /> 1
<br /> ..X UMBRELLA LIAR X OCCUR �EAS Fk C7L`.awURRENP"°F S 6 OOOA Q0Q
<br /> A EXCESS LIAR CLAICAS°MADE AGGHBEGA E `S 6 000 000
<br /> ..... ........ ... _........ ....... ......—._._._...— r r —_
<br /> V.7EC7..I...... Pt E:.NIT ION 5 5 2162397 412/'2015 4,/1.,/2016 S
<br /> WORKERS COMPENSATION PER ,.� OTH9
<br /> AND EMPLOYER'S'LIABILITY _.STATUTE,
<br /> ANY PRO.1PRIIETOrLJPARTNEIRIE.XECV TI'VE NIA
<br /> ...... E.L.EACH ACODENT ,S 1.,.000 000.
<br /> Oi"'F'CERWEMBER EXCLUDED? I ..— .... .. '... ..... ,...
<br /> L......
<br /> (Maeidatory In NH) PwC1010364—TEMP 4/1/2015 9/1/2016 r L..,,,.D15I-.A"`Ew,,,,EA 1 .0
<br /> VI yes,doscnbe tander ...
<br /> DEESCR I F11*N OF OPERATIONS below E ..OISEASE.-POLICY LIMIT' S 1,000,000
<br /> DESCRIPTION OF OPERATIONS P LOCATIONS J VEHICLES IACORD 101,AddlVonal Remarks Schedule.,,may'be attached If more space Is required)
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> (919)644-332.4
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> orange County Department: of Purchasing THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Central Services ACCORDANCE WITH THE POLICY PROVISIONS,
<br /> PO Box 8181
<br /> Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE
<br /> ;,tom°,Ar,rf°; mitclr^f/°�'d!1,";Y
<br /> 1988-2014 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
<br /> INS025 owodoia
<br />
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