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DocuSign Envelope ID:20877915-9004-438F-A177-54177939AE44 <br /> '��� �' oA"[E{tdMlaatYYYYI <br /> THIS CERTIFICATE I$ISSUEIXAS A jP1AVER"OF INFOWAtiON1 C?I+UY A�WtONVtRS.IaT 106HYS•UAbN THE CERTIFiCATIi HOLDER, THIS <br /> 'CERTiC pit non NOT AFFiRNIATtvay OR NEC,A,TIVi LY.AhIEFI�?.t Xrgo OR ALTER THE POVFFtAGE.'AI-rOR0ED BY THE POLICIES <br /> `1380W. -t'HIS.'CERTIFICAfE OF 1f1S�UhANCE bOES AOT C€)NSTIfUTE A'CONTRA&BETWEEN THE ISSUING INSURER($), AIITHIORMED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERT€FICATE HOLDER, t <br /> tMP5RTANT7 if.the certiffcatwholdAp Is at}ADDITIONZ INSt7ROD,(he poliby(fes)must•be.endbrsed. If SUBROGATION I$WAIVED,subject to <br /> the tarins and conditions of thaL pollcy,Certain faollules may require an ondorsemenL A statement on this certiffoata does not corifarrights to the <br /> a©rflflnate holderfri lieu of such apdorsement(s). <br /> PRODUCER- DONTAO7'.7ulie siaerriore <br /> BE <br /> 919 459-BCOtI <br /> ??eXnik Iusuianee & Financial, SESrtt`ic+�s �:( }. <br /> 100 Ri.dgatievt Dr1VQ S a�iXie.s3zemn pelnik,ecim <br /> Suite 100 �UO�ttDtEF�R1o#�lS07500 <br /> �'&x. "..._... NC's '2751 . ._..�,� iN51TNEIt€SI.A1;FtlnDING GAVSFkAGIi -„._,...�-.._ RAID <br /> iWsuRao HBuRERAirrankeranutli Lfi1.'Lug lna8 0a _ y mµ .398 <br /> ili9URER9;3iaildexs kiutual xsYSUr_aztae Gr7 _„_ ~' <br /> JUDY 1) :S ROOKS CONTRACTOR ixcC <br /> • IttsnRRt o:Rsseit 7:�n urance .Com ar.�+�.._�.:....�... „-..- • <br /> 1195 BEAL RD <br /> GOLDSTON NC 27252--9995 F <br /> ' NI$URFR-P e ! <br /> COVERAGEA c tTl lcATi~fJUNiU�RCs� 2ltiq>3 3 f#t S/lSIGN: I} )TIBER. +w <br /> •ii'y <br /> THIS IS TO CERTIFY THAT THE i'i LiClf s t]F INSUiiANCE i ISTEISBEI OW.Hat BEEN IS$Ut D'TO THE IhiSUftEL?,NAMECI tgOVE FOR;THI C'+ <br /> INP.iCATED, N NITHSTANDING ANY REQUIREMENT,MM.dR`CON*NTION OF ANY'Ct NTRACT OR Q'fHJER DOCUMENT WITH RESPECT y.Q.3NHIICHI Yffts � <br /> CEIRTINWE MAY BE ISSU15D OR MAY PERTAiNT 111E INSUERANGE Ate ORD9b-8Y THE POLICIES DESCRIBER'H. ALL TIC T11RMS, <br /> EXCLUSIONS AND C014DITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BI EI i REDLICI D k3Y 1�1�i15 CLAtM3. <br /> iNNS� �_...._.....�...�..._ R �E"D`tc "iSCfc. i+ __� •,.�t. <br /> 4TR TYPE OFiNSURANae t p17CY MINCER DD M D LIMITS <br /> aEN6RAL•LlAtstLITY EACHOCOcU�Ra CE s 3,'OpO:rfa'bti ,� •;y <br /> X Cg!AIVRCIALGENERAI,LiAAMV R 3 E <br /> A W10-MAOa 1z OCCUR Z/19/201 /18/3012 naEaRxP(A reR r..�.s _ r4oC• #, <br /> All 2.rti0,1):'OQi7q:€' <br /> GFJTLAGGnWATELNWAP IE6PER; <br /> X P ICY PRtf I Iwo <br /> AUTOMOBILE LIASILI'rY /Cph+�4Ei�F5'�Pp <br /> ANYAM HODILYIN1UaY{ParpRic nl <br /> A At I;OWNED AUY'OS 8000159 /18/2ti1i 118/2012 <br /> 11011V INJURY(P4?WdOW <br /> F• SCHEOULObAUYOS <br /> PROPF3I'FY'pAitiAGE �•r'.y'� <br /> �+ ARM ALMOS IPa(etzS70IikI S ......._... _ •"t?` <br /> NON-OWNEPALt1OS <br /> X UMBRkLA WAR OCCUR FACrtOCOtlRRENGI s 6}dOd;€)€)Q •;;';ry''� <br /> ExcESSLtAB. DLAItiB-644i}F ,l+�GREGAYE �--r. g ti r 0{}O r(�0{J- •'}';r <br /> DEOUGMILE <br /> A. X RE`i 411ON S 10,000 2/18/2011 /18/2012 S <br /> y � <br /> G AT0 <br /> 6 0fI <br /> .3.+ <br /> , <br /> WDRKeRSCCMPENSATiON <br /> AND OAPLOYERS UAMTIH <br /> A Gil <br /> P� P % E ApD 1LQOU <br /> bG D?• <br /> {MRttdalory In NNJ 10OA841 WFCFlenER ExCLUDG /19/2071 /19/9012 <br /> E L gISEABE. I!TR4TSYE $ 1 004 000 <br /> -0 EeCRIPTIONOP P01A3'4lf3brNak i~L.ClsEASE:POLIdYtIMIT 5 1 000:,000 <br /> G Motor Truck Caxt .' 512128 /7/2011 17/7012 Lsr:,Il $25;Ot}b ' <br /> y'jt <br /> DE9GRIpriON aP CPERATlDNa1 LOCATIONS I K�HiCLI S(Attach ACORB tUt,'AddlilgtraT kt rrryarks&cliGdsl(v,[I mntn xltaCr 18 rrqulnedl ”? <br /> CERTIFICATE HOLDER CANCELLATION <br /> (919)661-9038 51-16ULD ANY olz THE AadoVE DEsmisM POLICIES 135 CANCELLER BZPORE <br /> T14$.E'YPiRATION bATE THEREOF, NOTICE WILL HE RI LIVERED IN <br /> ACCT?iR,i'r1dE W171i THE POLICY PROVISIONS., <br /> AUTNoravk0 RnPREMTATIVE <br /> +pulse.-Si�emnr�/,pS2t•3 �l�,tt,:v�'�”' <br /> ACORD 25(2009109) O 1988.2009 ACORD CORPORATION.All rights reserved. <br /> IN5025{onaDEl The ACORD name and logo are registered marka of ACORD <br />