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DocuSign Envelope ID: C2FO7997-2159-4B59-853C-E452E58C9FOB <br /> GATEW-1 OP ID:SF <br /> CERTIFICATE OF LIABILITY INSURANCE P70EII IMMl1201 Y) <br /> l07l 201(i <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 INSURERS), 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 endorsements). <br /> cW <br /> PRODUCER NAAME;" Tara J.Smithwick <br /> First Insurance Services,Inc. PHONE 919.941 0549atc Noj:-919-941.0135 <br /> P.O.Box 13687 AIG No.E,dI; <br /> RTP,NC 27709 E-MAIL <br /> Tara J.Smithwick <br /> INSURER{S}AFFORDING COVERAGE NAIC q <br /> INSURER A:Montgomery Insurance Companies 24198 <br /> INSURED Gateway Building Company INSURERB:Peerless Insurance Company 24188 <br /> PO Box 3814 INSURER 0: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 /> ILTR D POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE POLICY NUMBER MMlaDf{YYY MMlDDftYYY <br /> A X COMMERCIAL GENERAL LIABILITY EACHOCCURRENGE $ 1,x00,00 <br /> CLAIMS-MADE N OCCUR BKA65526172 04/3012015 04130/2016 PREMISES Eaoocurrence s 1x0,00 <br /> MED EXP(Any one person) $ 10,000 <br /> PERSONAL&AOV INJURY $ 1,000,00 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,00 <br /> POLICY PRO- ❑LOG PROOUGTS-COMP1aPAGG $ <br /> 3,000,00 <br /> JECT <br /> S <br /> OTHER: <br /> COMFr <br /> AUTOMOBILE LIABILITY (Ea accientSiNGLELIMIT S 1,000,00 <br /> B X ANY AUTO BAS55625172 04/30/2015 0413012016 BODILY INJURY(Per person) S <br /> ALL OV NED SCHEDULED BODILY INJURY(Per accident) S <br /> AUTOS AUTOS PROPERTY DAMAGE <br /> NON-OWNED Peraccdent $ <br /> X HIREDAUTOS X AUTOS <br /> $ <br /> X UMBRELLA LIAO X OCCUR EACH OCCURRENCE S 1,000,00 <br /> A EXCESS LIAO CLAIMS-MADE US01456626172 04/3012018 04/3012016 AGGREGATE _ 5 .. 1,000,00 <br /> QED X RETENTION§ $ <br /> WORKERS COMPENSATION X STATUTE ERH <br /> AND EMPLOYERS'LIABILITY YIN XWA55626172 04130/2015 0413012016 E,L.EACH ACCIDENT $ 1,000,00 <br /> B ANY PROPRiETORIPARTNERtEXECttTiVE NIA <br /> (Mandatory OFFICERiMEMBER F�CCLUDEO? EXCLUDE ROBIN J.MOORE E.L.DISEASE-FAEMPLOYEE]$ 1,000,00 <br /> (Mandatory to NHj <br /> If y25,descx ba under E.L.DISEASE-POLICY LIMIT $ 1,000,00 <br /> DESCRIPTION OF OPERATIONS be!. <br /> C Leased&Rented IMP048356900 0510112015 05/01/2016 Limit 260,x0 <br /> Equipment Ded 1,00 <br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(ACORD 1101,Additional Remarks Schedule,may be attached If more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> ORANGES <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Orange County DEAPR 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 />