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DocuSign Envelope ID:A6400E9C-C30B-4768-894A-52E96E6C93A4
<br /> -J••� DATE(MM/DD/YYYY)
<br /> AiACC:01/20® CERTIFICATE OF LIABILITY INSURANCE 01/19/2017
<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 have ADDITIONAL INSURED provisions or be endorsed. m
<br /> If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on
<br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). c
<br /> PRODUCER CONTACT
<br /> NAME:
<br /> Aon Risk Services South, Inc. PHONE FAX 1,-
<br /> Richmond VA Office (A/C.No.Ext): (866) 283-7122 (A/C.No.): (800) 363-0105
<br /> 7325 Beaufont Springs Drive E-MAIL 0
<br /> Suite 300 ADDRESS: _
<br /> Richmond vA 23225 USA
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURED INSURER A: Columbia Casualty Company 31127
<br /> Davenport & Company, LLC INSURER B: Travelers Property Cas Co of America 25674
<br /> One James Center
<br /> 901 E. Cary Street INSURER C: Federal Insurance Company 20281
<br /> Suite 1100 INSURER D: Great Northern Insurance Co. 20303
<br /> Richmond vA 23219-4037 USA
<br /> INSURER E: Chubb Indemnity Insurance Co. 12777
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:570065307739 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. Limits shown are as requested
<br /> INSR ADDL SUBR POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DDIYYYY (MM/DD/YYYY) LIMITS
<br /> D X COMMERCIAL GENERAL LIABILITY 35979076 12/31/2016 12/31/2017 EACH OCCURRENCE $1,000,000
<br /> DAMAGE TO RENTED
<br /> CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $1,000,000
<br /> MED EXP(Any one person) $10,000
<br /> PERSONAL&ADV INJURY $1,000,000 M
<br /> GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 o
<br /> POLICY PR COT- X LOC PRODUCTS-COMP/OPAGG Included u,
<br /> • o
<br /> OTHER: o
<br /> n-
<br /> D 7357-27-99 12/31/201612/31/2017 COMBINED SINGLE LIMIT u,
<br /> AUTOMOBILE LIABILITY $1,OOO,OOO
<br /> (Ea accident) ..
<br /> ANY AUTO BODILY INJURY(Per person) 0
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) d
<br /> AUTOS ONLY AUTOS • '"'
<br /> X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE t6
<br /> ONLY F
<br /> AUTOS ONLY (Per accident)
<br /> 1:
<br /> d
<br /> C X UMBRELLA LIAB X OCCUR 79884900 12/31/2016 12/31/2017 EACH OCCURRENCE $10,000,000.
<br /> 10,000,000 U
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000
<br /> DED RETENTION
<br /> E WORKERS COMPENSATION AND 71746657 12/31/2016 12/31/2017 X I PER OTH-
<br /> EMPLOYERS'LIABILITY Y/N STATUTE 1 ER
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000
<br /> OFFICER/MEMBER EXCLUDED? N N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000-
<br /> A Fin inst E&O 596535845 12/31/2016 12/31/2017 Limit $5,000,000
<br /> Claims Made Retention $1,000,000 IIMI
<br /> SIR applies per policy terms & conditions
<br /> MG
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Certificate Holder is included as Additional Insured in accordance with the policy provisions of the General Liability policy.
<br /> ,:--
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br /> EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
<br /> POLICY PROVISIONS. rEi
<br /> Orange County, NC AUTHORIZED REPRESENTATIVE F
<br /> 200 South Cameron Street I.
<br /> Hillsborough NC 27278 USA [ /�+ fix/- y/fy ar
<br /> t—MFG. s. t Gt,e t9�e✓ ,1, M
<br /> III
<br /> ©1988-2015 ACORD CORPORATION.All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br />
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