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–DocuSign Envelope ID:49F804DF-69A6-4A6E-B52D-8629BF840373 — - <br /> ( <br /> -----) n <br /> DATE ompoirryti <br /> CERTIFICATE OF LIABILITY INSURANCE 01/210016 <br /> ke.----' <br /> ,....... <br /> PRODUCER _____ <br /> THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION <br /> Mae•Tke TntereNe Iltenty,Inc <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> 27101.Puerle Reel5tAte 200 <br /> HOLDER. THIS CERTIFICATE DOES NOT AMMEND, EXTEND OR • <br /> • <br /> MIssicn%Rein,CA 92691, <br /> ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, <br /> ' B77.4 38.7459 <br /> INSURERS AFFORDING COVERAGE . NAIL II <br /> INSURED <br /> MUD REA A:PTele delp•Ya IndcreCey frDueence Compary TRISB <br /> • <br /> STeve KLei <br /> INSURER 11, <br /> .. <br /> dee:US Tee Kwon OD Center,Inc. <br /> INSURER C <br /> 15201 Rose Geo:1E1Ln <br /> INSURER 0: <br /> 64Thern,NC 27202-BETO <br /> INSURER ET <br /> COVERAGES - <br /> • <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br /> ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERIFICATION MAY BE ISSUED OR <br /> MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH <br /> POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, <br /> INSR AWL <br /> POU CY EFFECTIVE POLICY EXPIRATION <br /> . <br /> LTA I NSITT1 TYPE OF INsURAN(E Po TICY NuDITI ER PATE(M.2.1/00/TYVY) bA7C(MMifloreYeY1 UMRS <br /> A X CENTRAL ITABILITY INIPX539280-CO5 02/05/t016 03/05/2017 EACH OCCUR ENCE <br /> 51,020,000 <br /> Ill COMTAFPCIC.GENERAL UALTIUTY . <br /> . <br /> PR..EMIrES I.EaRecC8crurr'enCel 5100,000 <br /> Ull (TANS MADE El OcCUR <br /> MEO IV(Any Tsele person) PACO <br /> n PROFESSIONAL LIABILITY <br /> PERSONAL BADV INJURY $1.000,020 <br /> GENERAL AGGREGATE . $3,000,0G0 <br /> GENT AGGREGATE OMIT APPLTES PEP: <br /> PRODUCTS-COMP/OP AGO $3.000,000 <br /> 111 POtICY PROTECT H LOC <br /> IIII AUTOMOBILE LIABILITY <br /> COMBINED MOLT WAR <br /> KA widen) <br /> ANV AUTO <br /> III At(OWNED AUTOS <br /> DODILY ROM <br /> . III WAN-kW AUTOS <br /> Per pi rSan) <br /> III HIRED AUTOS <br /> 111 <br /> BOORT INJURY <br /> 1111 NON-OINNED AUTOS <br /> (Per etcPlefil <br /> III <br /> PROPERTY DAMAGE <br /> il <br /> (Pe,aolln1) <br /> ••---- 1111111111Min AUTO ONLY ACCIDENT <br /> OTHER THAN TRACY al <br /> AUTO ONLY; <br /> AGO <br /> EXCESS/umBRELLA LEAN LITY <br /> 111,ACTRE".":"" MI <br /> oca„, E CLAMS TAM( <br /> le ROETEF 7:01 ON!.E• <br /> 4Zp-t.M'tiA'armE'r-, "' ° Y IN <br /> III I 7"avel a r s 1111 TB <br /> 11111M.11 <br /> gliciE4MgaxPMTAUREcur I‘r. Li <br /> EE.1t:DE:71 AEG CI:JAE AffEwLou <br /> (Mande tory DT tINJ <br /> ISMIrAdIVVI$Z1Srb.:-Iaw EL DTS€ASC-POLICY lIMIT <br /> Il 01ìR <br /> DESCRIPTION OF OP&RATIONS/LOCATIONS/VEITICILS/EXCLUSTONS AODED AY F.NOWISTBITNT/SPECIAL PROVISIONS <br /> • <br /> III,todersload and egTe Ed(hal the TelToMre et fry h aeded as in iddnil!nsored Dot onITT with tespect(s)to the operations RI The nrced Inivreel except Thal ITTLBRy resutrng Om the Winona'IATurecTs We <br /> 1-,E;Igente. <br /> CERTIFICATE HOLDER <br /> CANCELLATION <br /> snowp ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED REFORE THE EXPIRATION nAik <br /> owse COTT Tly Mtn:PITIT MeenietTeent <br /> THEREDF,TNT ISSUING INSURER WILL ENDEAVOR TO MAIL 10 OATS WRITTEN Noucc 10 THE <br /> 2C4 5 Ca Tn.econ 51,PO BcTIT BUD <br /> CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO no so SHALL IMPOSE NO OBUOATION OR <br /> HMI:mouth,TIC 27278-' <br /> IIABILITY OF Ally KIND UPON THE INSURER./TS AGENTS OR REPREsTNTATIVES. <br /> AUTHORITECT REPRESENTATIVE <br /> . <br /> ( , <br /> ._.... <br /> • <br /> ACORD 25(2009/01) <br /> 0 19882009 ACORD CORPORATION.All rights reserved, <br /> The ACORD name and[ago are registered marks of ACORD <br /> — — • <br />