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<br /> DocuSign Envelope IID E316C9D7-7607-400B-988E-8A99DF47DF8C
<br /> ....--'7.71 .. OP ID:KR
<br /> ACC:ORLY.
<br /> ‘,_,,,....-- • . • •-•': . • CERTIFICATE OF LIABILITY INSURANCE OATS OMAIDD/YYTY)
<br /> • ' . 10/01/2015
<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 /> ,..
<br /> IMPORTANT:• If the certificate holder..is:linADDITIONAL INSURED,the pollcgies)must he 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 tuch endorsement s. •
<br /> PRODUCER. Nam Kimberly Rhodes •
<br /> CITIZENS INSURANCE AGENCY FAX •
<br /> PHONE .. . 252492-4061• oc,No:252492-6256
<br /> P 0 BOX 109 ,,.41Cd1b...f411:
<br /> HENDERSON,NC 27536 E4011Mc
<br /> ADDRESS:kim o"!,ncegent,com
<br /> House AccounUJoel T.Cheatham _. ... . ,...„ , ..,..„ _. —
<br /> liditifitIdeft al al 1—+41 • • • ' ••
<br /> c mom/(t)a;.....1.4,--•..4$-it •
<br /> INSURER(I0 AFFORDINO.COVERAOE NAIC 0
<br /> *„ . .. • .
<br /> INSURED .El.Ftituro,Inc. • . INSURER A 1 Scottsdale Insurance Company
<br /> .136 E Chapel Hill Street muerte 0:LIBERTY MUTUAL INSURANCE
<br /> Durham,NC 27701 —
<br /> INSURERC:
<br /> INSURER 0:
<br /> k 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 /> Ma .: . .. i poL EFF icy . PO ir CI a•Ems .
<br /> LTR TYPE OF INSURANCE LI
<br /> t :1 POCY/I MBE- ■ „ on • M Y • LIMITS ______
<br /> GENERAL UAGIUTY EACH•OCCURRENCE s 1,00000
<br /> A COMMERCIALGENEFM LIABILITY :x
<br /> ill
<br /> •CLAIMS-WOE'(iji OccuR •PS0066908 • • 10/0512015 10/0512018 .I.
<br /> 4:1;;MSES Ea 1. le . $
<br /> 300,000
<br /> MED EXP(Any ono perosn) $
<br /> 5,000
<br /> MI PERSONAL IL ADV INJURY $ 1,000,000
<br /> GENERAL AGGREGATE $ 3,000,000
<br /> GEM AGGREGATE LIMIT APPLIES PER: . -COMP/OP AGG $ 3,000,000
<br /> X i POLICY I I .1.1207 El LOC . $
<br /> AUTOMOBILE LIABILITY . • COMBINED SINGLE LIMIT s 1,000,000
<br /> (Ea accident)
<br /> . .. • I ANY AUTO
<br /> BODILY INJURY(Per parsotq $
<br /> ALL OVVNED AUTOS .
<br /> BODILY INJURY(Per ardent) $
<br /> SCHEDULED AUTOS
<br /> PROPERTY DAMAGE
<br /> A LI HIRED AUTOS OPS0086908 1010512015 10105/2016 (PER ACCIDENT) $
<br /> A El NON4OWNED AUTOS OPS0088908 10/0512015 10/05(2016 $
<br /> $
<br /> III UMBRELLA UAB . NI OCCUR EACH OCCURRENCE $
<br /> . al
<br /> EXCESS UM' II CLAIMS4MADE AGGREGATE s•al DEDUCIBLE $
<br /> U RETENTION. S • $
<br /> WORKERS COMPENSATION • WC STATU. OTH.
<br /> AND EMPLOYERS°LIABILITY YIN i■ t,,
<br /> .11112/2014 11/12/2015 EL.EACH ACCIDENT E_.
<br /> B ANY PROPRIETORIPARTNER/EXECUTIVE 0 • WC2-541.438700-014 S • 500,000
<br /> OFfICERIMEMBER EXCLUDED? NI A
<br /> • • Mandatory In NH) • EL,DISEASE.EA EMPLOYEE S 500,000
<br /> . . Byea'describe under
<br /> •. DESCRIPTION OF OPERATIONS below • Et.DISEASE,.POLICY LIMIT $ 500,000
<br /> • A Professional Liab. • •1 ', lOPS0085908 10105/2015 1010512018 Ea Claim• 1,000,000
<br /> • • Claims Made. • " ..1 • !RETRO 10105/05 . Aggregate 3,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Addlilana1 Remarks Ilahadtdo,Hamm space Is required)
<br /> Certificate holder is additionalineured under the General Liability,but
<br /> only with respects..to Operations Of the Named insurea.
<br /> 1.............„._
<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 /> . . ...Orange County • ACCORDANCE vim THE POLICY PROVISIONS.
<br /> Attn:Finance Dept
<br /> 200 S Cameron Street .. . AUTH IZED REPhESENTATIVE
<br /> PO Box 8181 - • Ho se Accou tkloe T.éheatham .
<br /> Hillsboro,
<br /> I NC 27278
<br /> ,•
<br /> 0 19 8-2009 AbORt CORPORATION. All rights reserved.
<br /> ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD
<br />
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