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DocuSign Envelope ID:AD43A22F-6754-4919-9754-D100376EF19E <br /> �,,.....aN NEWRIVE-08 NPOTEAT <br /> AC'ORL7. CERTIFICATE OF LIABILITY INSURANCE DATE 03/23/2017Y) <br /> �,.--� 03!2312017 <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. <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). <br /> PRODUCER <br /> Jackson Insurance Agency PRONE N ):(276)728-4212 I FAX Ne):(888)632-0342 <br /> 208 N.Main 2 �:nicole @insureblueridge.com <br /> Hlllsvilre,VA 24343 <br /> INSURERS)AFFORDING COVERAGE NAIL N <br /> INSURER A:Lloyds Companies <br /> INSURED INSURER B: <br /> New River Tire Recycling INSURER C <br /> Benjamin Bryant <br /> P O Box 1376 INSURER 0: <br /> HlllavIllo,VA 24343-7375 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 /> ILT$RR INSURANCE TYPE OF INSU (YSD vivo POLICY NUMBER (MWDDrYYYY) rMwDDrIYYY1 LIMITS <br /> A X COMMERCIAL GENERALLWBIUTY EACH OCCURRENCE $ 1,000,000 <br /> CLAIMS-MADE © OCCUR PGIARK06127-00 04/1812016 04/1812017 pDatgraVotiggerocei $ 100,000 <br /> MED EXP(Any one person) $ 5,000 <br /> PERSONAL&A INJURY 3 1,000,000 <br /> DV <br /> GENT_AGGREGATE pLRIMpIT.APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> POLICY n mr4 El LOG PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> — OTHER. SITE POLLUTION $ 1,000,000 <br /> AUTOMOBILE LIABILITY (Ea MBI ent)SINGLE LIMIT –$ <br /> ANY AUTO Ep BODILY INJURY(Per person) S <br /> —_ MANED ONLY — <br /> AUTOS BODILY BODILY INJURY(Per=Went) $ <br /> _, AUTOS ONLY — AUTOS ONLY W eflh) AGE 3 <br /> $ <br /> UMBRELLA UAB _ OCCUR EACH OCCURRENCE $ <br /> EXCESS LU1B CLAIMS-MADE AGGREGATE $ <br /> DED I I RETENTION$ $ <br /> WORKERS COMPENSATION I PER STATUTE I I ET <br /> AND EMPLOYERS'LIABILITY <br /> ANY PROPRIIEMTgORRIPARTNEWEXECUTIVE YQ N f A E.L.EACH ACCIDENT S <br /> Fi�Ip NHSL� E.L.DISEASE-EA EMPLOYEE S <br /> It yes,desatbe under E.L.DISEASE-POLICY LIMIT S <br /> DESCRIPTION OF OPERATIONS below <br /> DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more apace Is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Orange County NC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 200 S Cameron St <br /> PO Box 8181 <br /> Hillsborough,NC 27278 AUTHORIZED REPRESENTATIVE <br /> )14.6tElAttAk <br /> ACORD 25(2016/03) 0 1888-2015 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />