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DocuSign Envelope ID: CDA69B56-08FD-456F-B2ED-899D72C2457C <br /> PELIBEI OP ID: C2 <br /> ACORO' DATE(MM/DD/YYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE 12/16/2016 <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 Philip S.Wolf <br /> The Insurance Center of Durham <br /> 1920 Front St.,Suite 710 PHONE o,EXt�:919-471-2541 FAX No): 919-471-2132 <br /> P.O.Box 15369 E-MAIL <br /> Durham,NC 27704- ADDRESS: <br /> Philip S.Wolf INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A:Auto-Owners Insurance Co. 18988 <br /> INSURED Bernadette Pelissier INSURER B: <br /> &Vann Bennett <br /> 4516 Mystic Lane INSURER C <br /> Hillsborough, NC 27278-7588 INSURERD: <br /> INSURER E <br /> • <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 TYPE OF INSURANCE N W <br /> SD VD POLICY NUMBER POLICY EFF POLICY EXP <br /> ,(MM/DD/YYYY) (MM/DD/YYYY) LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> X 35257755 12/15/2016 12/15/2017 DAMAGE TO RENTED 100 000 <br /> CLAIMS-MADE OCCUR PREMISES„(Ea occurrence) $ � <br /> MED EXP(Any one person) $ 5,000 <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 <br /> POLICY PRO- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> JECT <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT + $ <br /> (Ea accident) <br /> ANY AUTO 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$ $ <br /> WORKERS COMPENSATION PER OTH- - <br /> AND EMPLOYERS'LIABILITY Y/N l STATUTE ....1 ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E .EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? N/A <br /> (Mandatory in NH) E .DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E .DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Ref 205&242 Persimmon Hill Lane Cedar Grove NC 27231 <br /> CERTIFICATE HOLDER CANCELLATION <br /> ORAN002 <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> g ty ACCORDANCE WITH THE POLICY PROVISIONS. <br /> PO Box 8181 <br /> Hillsborough, NC 27278 <br /> AUTHORIZED REPRESENTATIVE n <br /> 1 2 <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br />