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DocuSign Envelope ID:6B93A96D-42B0-4993-BD08-232787EF99B4
<br /> p,p DATE(MMIDDlYYYY)
<br /> AC' R�® CCF'���9C TE OF Li - DUTY Q�9S6� �CE 7/6/2016
<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 /> CONTACT Patty Miller
<br /> PRODUCER NAME:
<br /> PHONE (919)968-4611 FAX (919)968-0991
<br /> Business Insurers of Carolinas IAIC,No.Ext): _ (A/c,No:
<br /> 800 Eastowne Drive, Suite 208 aD�Ress:F'miller @business-insurers.com
<br /> PO Box 2536 INSURER(S)AFFORDING COVERAGE _ NAIC# j
<br /> Chapel Hill NC 27515-2536 INSuRERA:Tri-State Ins Co of Minnesota 31003 ,
<br /> INSURED INSURERBtUniOn Insurance Company 25844
<br /> CEA Associates, Inc INSURER C:Stonewood Ins. Co. 11828
<br /> 222 Cloister Court INSURER D:
<br /> INSURER E:
<br /> Chapel Hill NC 27514 INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:2016-2017 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 WAD CLAIMS,
<br /> INSR ADDL SUBR POLICY EFF ` POLICY EXP' LIMITS
<br /> LTR TYPE OF INSURANCE' 'nisi? Wm POLICY NUMBER IMMIDDIYYYYI (MMfDDIYYYY)
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> DAMAGE TO RENTED 300,000
<br /> A CLAIMS-MADE X 1 OCCUR PREMISES(Ea occurrence) $,
<br /> X Y ADV4298780 41 7/.9/2016 7/9/2017 MED EXP(Any one person) $ 10,000
<br /> PERSONAL&ADV INJURY $
<br /> GENERAL AGGREGATE $ 2,000,000
<br /> GEN'LAGGREGATE LIMIT APPLIES PER: -
<br /> pRp- f I PRODUCTS-COMP/OPAGG $ 2,000,000
<br /> X POLICY JECT t LOG $ 100,000
<br /> OTHER
<br /> L COMBINED SINGLE LIMIT
<br /> AUTOMOBILE LIABILITY _ (Ea accident) $ 1,000,000
<br /> BODILY INJURY(Per person) $
<br /> B X ANY AUTO
<br /> ALL OWNED SCHEDULED CNA4298862 41 7/9/2016 7/9/2017 BODILY INJURY(Per accident) $
<br /> X AUTOS x;AUTOS X y PROPERTY DAMAGE $
<br /> X HIRED AUTOS er accident)
<br /> X_AUTOS'NUUTOS TOS ED
<br /> Uninsured motorist HI split limit $ 1,000,000
<br /> X UMBRELLA LIAR X OCCUR CNA4298862 41 7/9/2016 7/9/2017 EACH OCCURRENCE $ 4,000,000
<br /> EXCESSLIAB CLAIMS-MADE Umbrella Follows Form GL AGGREGATE $ 4,000,000
<br /> DED RETENTION$ Auto, WC -$ .
<br /> WORKERS COMPENSATION X STATUTE , OERH
<br /> AND EMPLOYERS'LIABILITY Y f ry E.L.EACH ACCIDENT $ 500,000
<br /> ANY PROPRIETORIPARTNERIEXECUTIVE NIA -
<br /> C (Mandatory ER EXCLUDED? N y WC1000002205-2015A 12/31/2015 12/31/2016 E-L.DISEASE-EA EMPLOYEE $ 500,000
<br /> (Mandatory in NH)
<br /> If yes,describe under E.L.DISEASE-POLICY LIMIT $ 500,000,000
<br /> DESCRIPTION OF OPERATIONS below
<br /> DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES(ACORD,101,Additional Remarks Schedule,may he attached if more space Is required)
<br /> CERTIFICATE HOLDER _CANCELLATION
<br /> Orange County
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 131 West Margaret Lane
<br /> Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE
<br /> Patty Miller/PATTY z Via"
<br /> ©1988-2014 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
<br /> I NSO25120/4511
<br />
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