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DocuSign Envelope ID: F91F0115-EFC8-4DD2-83F6-8AA6A5EFF7D8 <br /> J <br /> ,-,"'""*""t DATE(MM/DD/YYYY) <br /> ffi <br /> ,4Ra CERTIFICATE OF LIABILITY INSURANCE 06/11/2015 <br /> ( PRODUCER THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION <br /> ,( iguire Insurance Agency,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> 44 L01Puerta Real Suite 200 HOLDER. THIS CERTIFICATE DOES NOT AMMEND, EXTEND OR <br /> ,aflssIonVle)o,CA92691- ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> 877.438.7459 <br /> INSURERS AFFORDING COVERAGE NAIC# <br /> INSURED INSURER A:Philadelphia Indemnity Insurance Company 18058 <br /> Barbara Jan Lang INSURER B: <br /> 905 Cedar Fork Trail INSURER C: <br /> Chapel Hill,NC 27514- <br /> INSURER D: <br /> INSURER E: <br /> COVERAGES I' <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 ADD'L POLICY EFFECTIVE POLICY EXPIRATION <br /> LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YYYY) DATE(MM/DD/YYYY) LIMITS I�....! <br /> A X GENERAL LIABILITY PHPK596174-005 07/10/2015 07/10/2016 EACH OCCURENCE $2,000,000 <br /> COMMERCIAL GENERAL LIABILITY PREMISESi(Eaoccurrence) $100,000 <br /> CLAIMS MADE X OCCUR MED EXP(Any one person) $2,500 <br /> X PROFESSIONAL LIABILITY PERSONAL&ADV INJURY • $2,000,000 <br /> GENERAL AGGREGATE $4,000,000 <br /> - W <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS—COMP/OP AGG _ $4,000,000 <br /> POLICY n PROJECT I LOC Ilk <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> ANY AUTO (EA accident) <br /> ALL OWNED AUTOS BODILY INJURY U° <br /> SCHEDULED AUTOS (Per person) <br /> HIRED AUTOS BODILY INJURY t' <br /> NON-OWNED AUTOS (Per accident) <br /> PROPERTY DAMAGE <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY—EA ACCIDENT <br /> ANY AUTO OTHER THAN EA ACC <br /> AUTO ONLY: AGO <br /> EXCESS/UMBRELLA LIABILITY EACH OCCURENCE <br /> n OCCUR I I CLAIMS MADE • AGGREGATE <br /> - I <br /> DEDUCTIBLE - <br /> RETENTION <br /> WORKERS COMPENSATION AND I WC C STATU- I I 0RH <br /> EMPLOYERS'LIABILITY r/11+7 <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE <br /> OFFICER/MEMBER EXCLUDED? E.L.EACH ACCIDENT <br /> (Mandatory in NH) E.L.DISEASE—EA AMPLOYEE <br /> If yes describe under <br /> SPECIAL PROVISIONS below E.L.DISEASE—POLICY LIMIT <br /> OTHER <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br /> It Is understood and agreed that the following entity Is added as an additional Insured but only with respect(s)to the operations of the named insured except that liability resulting from the additional insured's sole <br /> negligence. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE <br /> , THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE <br /> CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR <br /> LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES, <br /> AUTHORIZED REPRESENTATIVE <br /> og <br /> , etr....4)............xs_ <br /> 9 <br /> i <br /> ACORD 25 (2009/01) © 1988-2009 ACORD CORPORATION.All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />