2015-631-E AMS - Carolina Cleaning Associates 137 W. Margaret Ln. cleaning services

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DocuSign Envelope ID: 17154650-24B9-4A0E-A055-AE398AFEDB1 F ACORN® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)8/7/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTA pp CT Clint Chappell NAME: Jennings Bryan-Chappell Insurance Services la°NN.Ext): (336)227-7458 (AC No): (336)343-1000 PO Box 1118 ADDRESS:clint@ jbcins.com INSURER(S)AFFORDING COVERAGE NAIC# Burlington NC 27216 INSURERA:Philadelphia Insurance Co INSURED INSURER B:United Heartland OE Enterprises, Inc. INSURER C: 348 Elizabeth Brady Road INSURERD: INSURER E: Hillsborough NC 27278 INSURERF: COVERAGES CERTIFICATE NUMBER:CL147300802 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED loo 000 COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ r A CLAIMS-MADE OCCUR X PHPK1198086 6/30/2014 6/30/2015 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 7 POLICY JECT PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 A X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED PHPK1198086 6/30/2014 6/30/2015 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) Medical payments $ 5,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 4,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 4,000,000 DED X RETENTION$ 10,000 PHUB465454 6/30/2014 6/30/2015 $ B WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) 2000007792 7/1/2014 7/1/2015 E.L.DISEASE-EA EMPLOYEE$ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 A Directors/Officers PHSD947272 6/30/2014 6/30/2015 D&O 3,000,000 A EPLI PHSD947272 6/30/2014 6/30/2015 EPLI 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Orange County ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 8181 Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE Clint Chappell/CC ( ",--,,- - ,--405 ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 onion'\nl Thn ArCIDn n,mn mind Irmo mire rnnic4nrnel rn,rlec of ArCIDr1