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DocuSign Envelope ID: D9639255-8147-4A2F-A760-941BDE078E48 TRIANO3 OP ID:AW
<br /> RL)° DATE(MM/DD/YYYY)
<br /> CERTIFICATE OF LIABILITY INSURANCE 09/19/2016
<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: Anita Chick
<br /> (Senn Dunn-High Point PHONE FAX
<br /> 1400 Eastchester Drive,St 200 ( c,Nch gm 336 878 7800 l i+vice Ndi. 336 841 5319
<br /> High Point,NC 27265
<br /> �ADDRESS.achick esen ndunn com
<br /> Small Business Accounts-HP
<br /> . .... �...... ��......
<br /> ................................... INSURER(S)AFFORDING COVERAGE NAIC#...... ....r........... .......,.,.........,.�...
<br /> INSURER A:Alliance Member Services 10023
<br /> INSURED Triangle Bikeworks INSURER B
<br /> Kevin Hicks
<br /> PO Box 17202 INSURER C
<br /> Chapel Hill, NC 27514 INSURER D
<br /> INSURER E: F........ .,.,. .
<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 /> INSR A D D L ix ... .,. POLICY EFF POLICY EX. ,..,
<br /> LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) LIMITS
<br /> A X cOMMERCIAL GENERAL LIABILITY OA EACH OCCURRENCE AGE'T 4 R 9 TEO
<br /> mm$ 1,000,0001
<br /> CLAIMS-MADE X OCCUR 2016-37804 06/11/2016 06/11/2017 PREMi ES(Ea oca rite/1001 $ 500,0001
<br /> MED EXP(Any one person) $ excluded
<br /> ....... .........
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GE 'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000
<br /> POLICY JECT LOC PRODUCTS COMP/OP AGG
<br /> PRO
<br /> $ 2,000,000
<br /> OTHER $
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT l 1,000,000
<br /> LEa accident)
<br /> A
<br /> AUTOS AUTOS (Per person) $
<br /> ALL OWNED SCHEDULED ANY AUTO
<br /> (Per INJURY Pe accident)r nt) $
<br /> accide
<br /> NON-OWNED PROPERTY DAMAGE
<br /> ......; HIRED AUTOS AUTOS „To,act,der..) ,... ...L$. .. ........_
<br /> I $
<br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $
<br /> -
<br /> CLAIMS MADE AGGREGATE
<br /> ---....._ EXCESS LIAB ..- $
<br /> DED I RETENTION$ $
<br /> WORKERS COMP N AT ION TY Y d N .... ... ......................_........... ..,�.�,. PEATUT'E,.m..,..,.,... E0 H-
<br /> AND ...,..... . ..........
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E .EACH ACCIDENT $
<br /> OFFICER/MEMBER EXCLUDED? N/A „........... ................. ........ ..
<br /> (Mandatory i NH) EMPLOYEE $
<br /> I If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT LIMIT $S
<br /> ..........
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required)
<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 (OC) ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Allen Coleman
<br /> 200 S. Cameron Street AUTHORIZED REPRESENTATIVE
<br /> i �� �
<br /> Hillsborough, NC 27278 � v
<br /> ©1988-2014 ACORD CORPORATION. All rights reserved,.
<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
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