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DocuSign Envelope ID: DEOD67EB-234A-428E-AD5D-E173255F6751 <br /> ACO °R CERTIFICATE OF LIABILITY INSURANCE DATE(MMIODJYYYY) <br /> 09/25/2015 <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 pollcy(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 CONTACT <br /> NAME: <br /> Tanya A Marsh lPN14C0.NN4,exU: FAX N al: <br /> 5410 NC HIGHWAY 55 ADDRESS: <br /> STEM INSURER(S)AFFOROINGCOVERAGE NAICM <br /> DURHAM NC 27713 INSURER A: NATIONWIDE MUTUAL FIRE INSURANCE COMP/ 23779 <br /> INSURED INSURERS: <br /> INSURER C: <br /> FUN 2 REF LLC INSURER D: <br /> 1105 INFINITY RD INSURER E: <br /> DURHAM NC 27712-9795 INSURERF: <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 /> 'HER TYPE OF INSURANCE IN SD SWVO POLICY NUMBER (MM,ODYIYYYY) IMMIoomYYI LIMITS <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> 1 CLAIMS MADE XJ OCCUR PREMISES(Ea ccomrence) $ 100,000 <br /> MED EXPjAny one person) $ 1,000 <br /> A X ACP GLGO 2245150455 08/1612015 08/16/2016 PERSONAL 8 AOV INJURY $ 1,000,000 <br /> _GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> X POLICY Vri LOC PRODUCTS-COMP/OP AGO $ 2,000,000 <br /> OTHER: <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> _(Ea accident) <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> HIRED AUTOS <br /> NON-OWNED WNED (Per aaEERR,dTY DAMAGE <br /> $ <br /> UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 <br /> A EXCESS LIAR CLAIMS-MADE ACP CAF 2245150455 08/16/2015 08/16/2016 AGGREGATE $ 1,000,000 <br /> DEO I RETENTION$ - -$ <br /> WORKERS COMPENSATION <br /> AND EMPLOYERS'LIABILITY YIN PER EERH <br /> ANYPROPRIETONPARTNERJEXECUTIVE E.L.EACH ACCIDENT -$ <br /> OFFICERIMEMREREXCLUDEDT NIA <br /> (Mandatory In NH) E_L.DISEASE-EAEMPLOYEE S <br /> it yes.describe under <br /> DESCRIPTION OF OPERATIONS brow E.L.DISEASE-POLICY LIMIT -$ <br /> DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached II more space Is required) <br /> CERTIFICATE HOLDER IS LISTED AS ADDITIONAL INSURED FOR LIABILITY. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ADDITIONAL INSURED ACCORDANCE WITH THE POLICY PROVISIONS. <br /> ORANGE COUNTY <br /> AUTHORIZED REPRESENTATIVE <br /> PO BOX 8181 E.LETITIA HUNTER <br /> HILLSBOROUGH NC 27278 <br /> O 1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br />