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DocuSign Envelope ID:8DOB4ODC-F492-4F8E-97D7-C920FA404B6A JERHRCO-01 CECH <br /> 14ICC]R/EX CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDlYYYY) <br /> 9/21/2016 <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 (732)747-0800 Nal"�NEacT Christina Ackerman <br /> Boynton&Boynton PHONE <br /> (AIC,No,Ed):(732)732 747-0800 1124 FAX <br /> (PJC,No): (732)732 530-4220 <br /> 21 Cedar Ave E-MAIL <br /> Fair Haven, NJ 07704 ADDRESS:cackerman @boyntonandboynton.com <br /> INSURER(S)AFFORDING COVERAGE NAIC p <br /> INSURERA:U S LIABILITY INSURANCE CO 25895 <br /> INSURED JER HR Group, LLC INSURER B: <br /> 36 West 44th Street INSURER C: <br /> Suite 707A INSURER D: <br /> New York, NY 10036 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 /> ADDL SUER POLICY EFF POLICY EXP <br /> ILTRR TYPE OF INSURANCE •N_SD WVD POLICY NUMBER JMMIDDIYYYYUMMIDDPYYYY) LIMITS <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ _ <br /> DAMAGE TO RENTED <br /> CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ <br /> MED EXP(Any one person) $ <br /> PERSONAL&ADV INJURY $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ <br /> POLICY JECT LOG PRODUCTS-COMPIOP AGG $ <br /> OTHER: <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> (Ea accident) <br /> ANY AUTO <br /> BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> NON-OWNED PROPERTY DAMAGE <br /> HIRED AUTOS AUTOS (Per accident) - <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ 1 r $ <br /> WORKERS COMPENSATION I 0TH- <br /> STATUTE I 0TH <br /> AND EMPLOYERS'LIABILITY <br /> Y 1 N <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE F.L.EACH ACCIDENT $ <br /> OFFICERVEMBER EXCLUDED? N 1 A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> A Errors&Omissions N N SP1561761 12/912015 12/9/2016 Annual Aggregate $1,000,000 <br /> A Errors&Omissions N N SP1561761 12/9/2015 12/9/2016 Deductible-Each Claim $5,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may he attached If more space Is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Forsyth County,Its Officials, Officers THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> &Employees <br /> Att: Risk Manager <br /> 201 N. Chestnut Street AUTHORIZED REPRESENTATIVE <br /> Winston Salem, NC 27101- <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD <br />