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DocuSign Envelope ID:63B49003-DB46-4935-A8E4-1 E08211 FDE8D
<br /> DIXON-2 OP ID: RJ
<br /> C-C,R© CERTIFICATE OF LIABILITY INSURANCE DATE(MM1DD/YYYY)
<br /> 06127/2016
<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 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 /> PRODUCER NAME:ACT Patton, Morgan&Clark
<br /> Patton,Morgan&Clark PHONE FAX
<br /> P O Box 1027 (Arc,No,Eat):
<br /> Canton, _(A/C,No): 828-648-2642
<br /> Canton,NC 28716 E-MAIL
<br /> Patton,Morgan&Clark ADDRESS:
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURER A:The Travelers Companies Inc,
<br /> INSURED Dixon Hughes Goodman LLP INSURER B
<br /> P.O. Box 3049
<br /> Asheville, NC 28802 INSURER C:
<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 /> INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP
<br /> LTR INSD WVD POLICY NUMBER (MMIDD/YYYY) (MM/DDIYYYY) LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X OCCUR 630-5E183024-INC-16 06/01/2016 06/01/2017 DAMAGE To RENTED
<br /> PREMISES(Ea occurrence) $ 1,000,000
<br /> MED EXP(Any one person) $ 10,000
<br /> PERSONAL 8 ADV INJURY $ 1,000,000
<br /> GE 'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000
<br /> X POLICY PJERCO LOC PRODUCTS $ 2,000,000
<br /> OTHER: $
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
<br /> (Ea accident) 1,000,000
<br /> A ANY AUTO BA-5E261842-16-CAG 06/01/2016 06/01/2017 BODILY INJURY(Per person) $
<br /> ALL OWNED ■ SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS AUTOS PROPERTY DAMAGE
<br /> X NON (Per accidanl)
<br /> HIRED AUTOS AVTOS-OWNED
<br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000
<br /> A EXCESS LIAB CLAIMS-MADE CUP-5878N805-TIL-16 06/01/2016 06/01/2017 AGGREGATE $ 10,000,000
<br /> DED X RETENTION$ 10000 $
<br /> WORKERS COMPENSATION X PER 0TH-
<br /> AND EMPLOYERS'LIABILITY -STATUTE ER
<br /> YIN
<br /> A ANY PROPRIETOR/PARTNER/EXECUTIVE UB-5E262525-16 06/01/2016 06/01/2017 E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBER EXCLUDED? N I A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 1,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> ORANGC5
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Orange County Health Dept. ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 300 W Tryon St.
<br /> Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE
<br /> ©1988-2014 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
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