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�1 DIXON-2 OR ID;CM
<br /> DocuSign Envelope ID:832DFDF3-2A7B-415B-AF03-6A9B7508B20F DATE(MM1DD/YYYY)
<br /> �� — CERTIFICATE OF LIABILITY INSURANCE 06/29/2017
<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.
<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 828-648-2632 CONTACT
<br /> NAME: Patton, Morgan&Clark
<br /> Patton,Morgan&Clark PHONE
<br /> 828-648-2632 1 FAX 828-648-2642
<br /> P 0 Box 1027 (Arc,No,Eat): (A/C,No):
<br /> Canton,NC 28716 ADDRESS:
<br /> Patton,Morgan&Clark INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURER A:The Travelers Companies Inc, 25682
<br /> INSURED Dixon Hughes Goodman LLP INSURERB:
<br /> P.O. Box 3049
<br /> INSURER C:
<br /> Asheville, NC 28802 •
<br /> INSURER 0:
<br /> 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 /> INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD VOID (MM/DD/YYYY),(MMIDD/YYYYF
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X OCCUR I630-5E183024-PHX-17 06/0112017 06/01/2018 DAMAGE TO RENTED 1,000,000
<br /> PREMISES(Ea occurrence) $
<br /> MED EXP Any one person) $ 10,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> X I POLICY PRO 2,000,000
<br /> JECT LOG PRODUCTS-COMP/OP AGG $
<br /> OTHER: _ '. i $
<br /> COMBINED SINGLE LIMIT 1,000,000
<br /> A AUTOMOBILE LIABILITY { (Ea accident) $
<br /> i.ANY AUTO BA-5E261842-17-CAG 06/01/2017!06/01/2018 BODILY INJURY(Per person) $
<br /> : OWNED SCHEDULED II
<br /> AUTOS ONLY AUTOS I BODILY INJURY(Per accident) $
<br /> X HIRED X NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY L . AUTOS ONLY (Per accident) ,$
<br /> I $
<br /> A X UMBRELLA LIAR 1 OCCUR � • EACH OCCURRENCE $ 10,000,000
<br /> EXCESS LIAB 1 CLAIMS-MADE 'I CUP-1J921907-TIL-17 0610112017'0610112018 10,000,000
<br /> AGGREGATE $
<br /> DED X RETENTION S 10000 i
<br /> A :WORKERS COMPENSATION '. X PLR 0TH-
<br /> IAND EMPLOYERS'LIABILITY
<br /> Y!N UB-5E262525-17 06/01/2017 06/01/2018 I STAr ER 1,000,000
<br /> ANY PROPRIETORIPARTNER/EXECUTIVE E L_EACH AC ACCIDENT $
<br /> I OFFICER/MEMBER EXCLUDED? N NIA I
<br /> I(Mandatory in NH) I E.L-DISEASE-EA EMPLOYEE $ 1'000'000
<br /> l If yes,describe under s j 1,000,000
<br /> DESCRIPTION OF OPERATIONS below - I E.L.DISEASE-POLICY LIMIT i $
<br /> I
<br /> I
<br /> I
<br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> ORANGC5
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Orange County Health Dept. ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 300 W Tryon St.
<br /> Hillsborough, NC 27278 AUTHORIZED REPRESENTAn 1
<br /> Patton, Morgan&C ark q
<br /> ACORD 25(2016/03) ©1988 2015 ODD CORPORAT(.17)
<br /> N. All rights r se A.
<br /> The ACORD name and logo are registered marks of A /
<br />
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