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DocuSign Envelope ID:OB0004FA-A182-4D23-AAC9-C4A5A4ED4213 <br /> GiLFSTI OP ID: C1 <br /> EJM <br /> CERTIFICATE OF LIABILITY INSURANCE C 08/ 5 <br /> 1MJDDN101 <br /> ........... <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 pci roust be endorsed, 4 SUBROGATION IS WAIVED,subject to <br /> the terms and conditions of tile policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder In flou of such enclorsement(s). <br /> PRODUCER CONTACT Ii S.Wolf <br /> The insurance Center of Durham P'h'rrrrrrr'P-­ .............. ------- <br /> 1920 Front SL,Suite 710 CA Exq�gjp-471-2541 FAX <br /> No:919-4 1-2132 <br /> P.O.Box 15369 N'�AIL <br /> AD DR S Phfl insurancecenterol'durharn.corn <br /> Durham,NC 27704- <br /> Philip S.Wolf RAGE <br /> INSURER AAuto-Owners;Insurance Co. 18988 <br /> -—----------- -7 <br /> INSURED StatIerW,GlifilIen& INSURER 6: <br /> Valerija Gilfillen INSURER C <br /> 3302 Saint Marys Rd. <br /> Hillsborough, NC 27278-9726 .!NSL)RE.RD_:_, <br /> JiIiISUR R,E: <br /> ................. <br /> IN�SURERE_:. <br /> COVERAGES CERTIFICATE NUMBER. REVISION NUMBER; <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUCI)TOTHE 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 CONDtTiONS OF SUCI I POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> A135 �9M­­-. .....1 .1 - I <br /> POLICYEFF POLICY EXP <br /> TYPE OF INSURANCE POLICY NUMBER: IMMi!2ofyY_yy1 LIMITS <br /> COMMERCIAL GENERAL I.JABILITY EACH OCCURRENCE $ 1,00,0,00( <br /> CLAWS-MADE �A OCCUR X T544774I11 0811112016 0811112016 $ 60,00( <br /> ....... MEn EXP(Arry one pimsen) $ 6,00( <br /> ............... <br /> PERSONAL&AOV INJURY Excludec <br /> (3EW,AGGRFGATF LIMIT APPLIES PER: GENEHAI,.AGGREGATE 2,000,00C <br /> I RD. <br /> X JLCT loc PRODUCTS <br /> POLICY P 2,000,00C <br /> OTHER <br /> AUrOMOBILEAJAWLITY COMBINED SINGLE LIMIT <br /> (Fa actideo) <br /> ANY AUTO ROOMY INJURY(Per pwaon) <br /> At L OWNED SCHLOAX11) 80MLY INJURY(Pair arcklerd) <br /> ARDS AnTO$ <br /> ITIRED AUTA NONDWN D id <br /> AO 0, <br /> UMBRELLA IJAH: OCCUR EACH OCCURRENCE. <br /> EXCESS LIAR CLAWS-MADE AGO,r EGAIE $ <br /> _ rat 17 RETENTION$ <br /> WORKE4M COMPENSATION TH- <br /> M D CM P EILITY YIN T o Y ROPRIETORIPARTNERIEXIECU Di [- -F'-L­"AHACq!PFe FIEWMEMBER EXCA, N I A analory�n NH) E.I[_DISEASE-:.EA T]IM <br /> $ <br /> 11 Ps'de-c be undef <br /> Ps OF OPERATIONS Wee, E,L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,AddMonal:Rari Schei may be attached If more space Is required) <br /> Management Consultant,Architect <br /> CERTIFICATE HOLDER CANCELLATION <br /> ORAN016 <br /> SHOULD ANY OF T14E 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 0 Box 8181 <br /> Hillsborough,INC 27278 AUTHORIZED REPRESENTA <br /> Philip S.Wolf <br /> D COR R <br /> Oc 1988-2014 ACOR!IATiON. Ali rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br />