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DocuSign Envelope ID:2F28EB01-83FA-4053-9050-C31 EOBA4EBA9 <br /> ONTAR-1 OP ID: HLB <br /> coRO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) <br /> `••--"''� 07/31/2015 <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 /> CONT <br /> PRODUCER NAMEACT LAMAR BUTLER,CIC <br /> INSURANCE SERVICE CENTER <br /> PO BOX 40736 A/CC ,NNi,Ext):910-592-3108 FAX No): 910-401-9244 <br /> FAYETTEVILLE,NC 28309 E-MAIL <br /> LAMAR BUTLER,CIC ADDRESS: Ibutler @ISCfay.COm <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A:THE HARTFORD 22357 <br /> INSURED ON TARGET PREPAREDNESS INSURER B: <br /> 266 BRADDOCK DR <br /> LILLINGTON, NC 27546 INSURERC: <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 /> IN SR TYPE OF INSURANCE I POLICY EFF POLICY EXP <br /> INSD WVD POLICY NUMBER /Y LIMITS <br /> (MM/DD YYY) (MM/DD/YYYY) <br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> CLAIMS-MADE X OCCUR 22SBAUN2187 08/01/2015 08/01/2016 DAMAGE TO RENTED 300 000 <br /> PREMISES(Ea occurrence) $ <br /> MED EXP(Any one person) $ 10,000 <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> POLICY PRO- <br /> JECT PRODUCTS-COMP/OP AGG $ 2,000 000 <br /> JECT � <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> (Ea accident) <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> NON-OWNED PROPERTY DAMAGE <br /> HIRED AUTOS AUTOS (Per accident) <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY X STATUTE x ER <br /> Y/N <br /> A ANY PROPRIETOR/PARTNER/EXECUTIVE 22WBCCT8451 08/01/2015 08/01/2016 E.L.EACH ACCIDENT $ 500,000 <br /> OFFICER/MEMBER EXCLUDED? N/A <br /> (Mandatory in NH) 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 /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <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 /> YADKIN COUNTY HEALTH DEPT ACCORDANCE WITH THE POLICY PROVISIONS. <br /> YADIN CO. NORTH CAROLINA <br /> PO BOX 548 AUTHORIZED REPRESENTATIVE <br /> YADKINVILLE, NC 27055 <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br />