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DocuSign Envelope ID:A8220AB0-3345-4910-8BD2-E45F145A9E95
<br /> -°"'1 CAME&CA-01 MCOLSON
<br /> A RO' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
<br /> 4........---- 9/6/2016
<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 CONTACT
<br /> NAME:
<br /> First Citizens Insurance Services PHONE 888 FAX 919
<br /> 4300 Six Forks Road (A/C,No,Ext):( )322-4678 (A/C,No): ( )716-2226
<br /> PO Box 29611 ADDRESS: insurance @firstcitizens.com
<br /> Raleigh,NC 27676-0611
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURER A:Essex Insurance Company 39020
<br /> INSURED INSURER B:National General Insurance Group
<br /> Cameron&Caer'on Assembly'Jlovi
<br /> m ng and Storage Inc. INSURER C:Torus National Insurance Company
<br /> 1418 Avondale cf. ;;%,^ INSURER D:Carolina Casualty Insurance Company
<br /> Suite 18
<br /> Durham,�NC"27701 s =: INSURER E:
<br /> INSURER F:
<br /> COVERAGES CE IFICATE,NUMBER: REVISION NUMBER:
<br /> THIS IS TO CERTIFY THAT"THE POLICIES OF INSURANC ;LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br /> INDICATED. NOTWITHSTANDING ANY REGOOtMENT TERM OR.CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br /> CERTIFICATE MAY BE ISSUED OR MAY iTAIN, THE;rI,NSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br /> EXCLUSIONS AND CONDITIONS OF SUCH 0'l LICIES.LIMITS%SHOWN Y HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> INSR %!•ADDL S41BR ' POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE ' INSD t: %POLICY N[UMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X OCCUR '',3AA107 01/17/2016 01/17/2017 PR SRENTED
<br /> I E PREMISES(( 100,000
<br /> occurrence) $ s 000
<br /> 5 000
<br /> MED EXP(Any one person) $ ,
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GE 'L AGGREGATE LIMITAPP'LI PEi a,„ GENERAL AGGREGATE $ 2,000,000
<br /> X POLICY rT LOG: PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> OTHER. $
<br /> AUTOMOBILE LIABILITY s.' r $ 1,000,000
<br /> COMBINED SINGLE LIMIT
<br /> of (Ea accident)
<br /> B ANY AUTO 4' , 2002957509 12/23/ 015 1 �, X016 BODILY INJURY(Per person) $
<br /> ALL OWNED{ SCHEDULED
<br /> X � BODILY INJURY(Per accident) $
<br /> AUTOS ;AUTOS '4',,:,f,/,,,...„
<br /> X -AXON-OWNED ;r°' ,! PROPERTY DAMAGE $
<br /> HIRED AUTOS „',),1 OS ,4,,,f,',/;:">,'''"' -' ,',-' ,`r, (Per accident)
<br /> $
<br /> X UMBRELLA LIAB X OCCUR �. ;EA'}H:OCCURRENCE $ 1,000,000
<br /> C EXCESS LIAB CLAIMS`MADE 84520D153AL1 07/1912016 09/17/2016 AGGREG $ 1,000,000
<br /> 1; 000 ,, ,r a,;o
<br /> DED X RETENTION$ s ,,; ;i'; , .: $
<br /> WORKERS COMPENSATION :' ` '
<br /> PER OTH
<br /> AND EMPLOYERS'LIABILITY Y/N 1 STATUTE ER
<br /> D ANY PROPRIETOR/PARTNER/EXECUTIVE BNUW0�1'I'32768 08/30/2016 08/30/2017 E L{EF ;H ACCIDENTS $ 500,000
<br /> OFFICER/MEMBER EXCLUDED? Y N/A '
<br /> (Mandatory in NH) E.L.�DISEASE EA EMPLOYEE, $ 500,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below -,;,r y, '_ „ E.L DISEASE 'P,OL-'ICY LIMIT;�$„ 500,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule May beattached if more space is required)
<br /> Re: Whitted Furniture Move
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> P.O.g County WITH THE POLICY PROVISIONS.
<br /> Hillsborough,NC 27278
<br /> AUTHORIZED REPRESENTATIVE
<br /> I
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<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
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