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DocuSign Envelope ID: BAA7622D-F739-4FEB-B14B-B1 59D1AAFE25
<br /> ACT0R17.)' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY)
<br /> 8/30/2016
<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 POLICII S
<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, subjeci Lo ,
<br /> the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to tho
<br /> certificate holder in lieu of such endorsement(s).
<br /> -..,...-
<br /> 1R0IA111,fi NAME at erine murnme
<br /> FAX
<br /> Catherine Hum PHONE mel (A/c.fig,,ExtL 9192869500 i(PVC,Nol; 91 926,09501
<br /> Around The Corner insurance Agency Inc. E-MAIL
<br /> ADDRESS: ,
<br /> /4 31 Broad St. INSURERS)AFFORDING COVERAGE NAIC 4
<br /> 14iiirairi NC 27705
<br /> 1 INSURER A: Atlantic Casualty
<br /> ' IM,,l1F0-D INSURER B: Travelers
<br /> Gonzalez Painters And Contractors INSURER C
<br /> 3518 (''iiess Rd INSURER D
<br /> i Dui ham, NC 27705 INSURER E
<br /> 1-- ,
<br /> i INSURER F: I
<br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br /> 16 CERTIFY 1 AT THE POLICIES OF INSURANCE LIS1 ED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIO 1
<br /> IINI/If IA h ED NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT 10 WHICH TI
<br /> 1 CFR I IF ICA TE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS
<br /> GL. .1.SIONS AND I:ONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> INU1 ACM SUBR —POUCY EFF POLICY EXP
<br /> 1 i k IYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MMIDD1YYYY) LIMITS 11
<br /> 01 NEPAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> I001039496-0 03/17/16 03/17/17 DAmkGE-TuRriTrEt)
<br /> 1 iiii COMMEW;IAL GLIILRAL LIABILI1‘, PREMISES tEa occur once) $ 100,,000
<br /> I ---I
<br /> c.i_prns-eAr,i i i OCCIJ MED EXP Any one person) $ 5,000
<br /> ' PERSONAL 8 ADV INJURY S 1.000,000 '
<br /> GENERAL AGGREGATE $ 2,Q00,000
<br /> I di IVL AGGRE OATS LIMCI"APPLIES PEP PRODUCTS-COMP/OP AGO $ _1_,000,000 ,
<br /> POLICY _11,,i,T 1 1 LOO 1 $
<br /> AU romoeiLE LIABILITY COMBINED SINGLE LIMIT
<br /> , (Ea acc(depti
<br /> A NY AUTO BODILY INJURY(Per person) $
<br /> ALL OWNED SCHEDULBD
<br /> BODILY INJURY(Per accident) $
<br /> AUTOS AUTOS
<br /> NON-OVVNED , PROPERTY DAMAGE $
<br /> I HELP.FOS AUTOS leer accident) ,
<br /> , $
<br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $
<br /> EXCESS LIAB .,CLAIMS-MADE ,I AGGREGATE $
<br /> 1 (
<br /> DOD I FETIII( IONS $
<br /> WORKERS COMPENSATION , WC STATU- ,--OTH
<br /> B AND EMPLOYERS'L!ABILITY YIN 6JUB9F56581-2-16 03/18/16 03/18/17 i__1,.LORY.JIMLIS_.,.L__Ell
<br /> PROPRIE TOR/PARTNER/EXECUTIVE i E L EACH ACCIDENT $ $1,000,000
<br /> r)FF■c,ERrMEMBER EXCLh/DED? y NIA
<br /> (Wiridatory in NH) E L DISEASE.EA EMPLOYEE $ $1,000,000 1
<br /> [1 y,,t3 OieSMEW undef
<br /> 1 DFiCRIP1 ION Or OPE PATIONS below E L DISEASE-POLICY LIMIT ,$ $1,000 000
<br /> I i
<br /> IS MIMI'NON OF OPERAIICJNS 1 LOCATIONS)VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required)
<br /> I _
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> ()RANCE COUNTY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE':
<br /> 00 BOX 8181 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> HILLSBOROUGH NC 27278 ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> AUTHORIZED REPRESENTATIVE
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<br /> ( Z,'Air 4/-17) '''' Lt./X,/., '„re a
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<br /> ©1988-2010 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD
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