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DocuSign Envelope ID: 5D99AC7B-FD9F-4A53-8F87-6D72739989E9 <br /> GATEW-1 OP ID: SF <br /> .�COF:Uh CERTIFICATE OF LIABILITY INSURANCE DATE(MhVDDIYYYY) <br /> 01107/2016 <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 polley(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 /> PRODUCER CONTACT Tara J.Smithwick <br /> First Insurance Services,Inc. NAME' <br /> P.0.Box 13687 A/c°No E ,,:919-941-0548 FAX No:919-941-0135 <br /> RTP,NC 27709 EMAIL <br /> Tara J.Smithwick ADDRESS: <br /> INSURER(S)AFFORDING COVERAGE NAIC N <br /> INSURERA:Montgomery,Insurance Companies 24198 <br /> INSURED Gateway Building Company INSURERS:Peerless Insurance Company 24198 <br /> PO Box 3814 INSURER C:Great American Ins Co-IM <br /> Durham, NC 27702 <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 /> BR _ POLICY EFF POLICY EXP -- I <br /> INSR TYPE OF INSURANCE POLICYNUMBER MMJDDIYYYY) (MWDDNYYYI LIMITS <br /> LTR <br /> A X COMMERCIAL GENERAL LIABILITY EAGH OCCURRENCE $ 1,000,00 <br /> CLAIMS-MADE a OCCUR BKA55525172 0413012015 0413012016 PREMISESO(E occurrence) $ 100,00 <br /> MED EXP(Anyone person) $ 10,000 <br /> PERSONAL&ADV INJURY $ 1,000,00 <br /> GEN'L AGGREGATE LIMIT APPOES PER: GENERAL AGGREGATE S 3,000,00 <br /> POLICY nX PR O 1:1 LOG PRODUCTS-COMPIOP AGG S 3,000,00 <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY GOMTd..")SINGLE LIMIT $ 1,000,00 <br /> Ea accidanl _ <br /> B X ANY AUTO BASS5525172 04/3012015 04/30/2016 BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> X TS X DAdAGE NON OWNED eaH REDAUTOS P £ cde $ <br /> $ <br /> X UMBRELLAUAB X OCCUR EACH OCCURRENCE S 1,000,00 <br /> A EXCESS LIAR CLAIMS-MADE US01455526172 04/3012015 04/30/2016 AGGREGATE $ 1,000,00 <br /> DER I X I RETENTION$ 0 $ <br /> WORKERS COMPENSATION x <br /> AND EMPLOYERS'LIABILITY STATUTE ER,H_ <br /> B ANY PROPRIETORIPARTNERtEXECUTIVE <br /> YIN XWASS525172 04/3012015 04/30/2016 E.L.EACH ACCIDENT $ 1,000+00 <br /> OFFIC(Mandator EMBEREXCLifDE07 NtA EXCLUDE ROBIN J.MOORS <br /> (h4andatory In NN) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 <br /> If yas,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 <br /> C Leased&Rented IMP048356900 0510112015 05/0112016 Limit 250,00 <br /> Equipment Ded 1,00 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 144,Additional Remarks Schedule,maybe attached if more space Is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> ORANGE6 <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Orange County DEAPR THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 302 W.Tryon St. <br /> PO BOX 8181 AUTHORIZED REPRESENTATIVE <br /> Hillsborough,NC 27278 <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD <br />