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DocuSign Envelope ID:78BE6605-1 CDA-4976-978A-2870E79AD11 E
<br /> _r-""N CERTIFICATE DATE OP I©.KR
<br /> .4C�►Rn __.RNSU_INSURANCE eakVDDrYWYI_ a
<br /> �� C ER MATTER OF ONLY AND CONFERS St NO RIGHTS UPON ..__... 09C2312d18
<br /> THIS CERTIFICATE IS ISSUED N 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,they i (l .. be end_ _ S_. _____N I._._�_ VED, _.,b)ect to
<br /> ertiflcate' ,_...__m � popsy{les) mutst be erndolxed. If SUBROt3ATION IS WAIVED,suM�-___.___
<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 /> _µ,a__ficat oldeLi ) of such antdDrsement s,
<br /> PRODUCER INS IN5t1RANCEiAGENCY
<br /> . _.._..w � ,_
<br /> HENDERSON,NC Le sMS�2$2+49-4dFiO m„m.._... . �Luc,,Nal 252-492-,625fi _...._µ
<br /> 27Tr38 enLcom
<br /> House Account/Joel T.Cheatham AplODOtt kima+mnca l
<br /> colN~��w'U” ELFGT 1 ..._...
<br /> _.__._ _...___ R _00.!c N.,._..._
<br /> It'ISGRsD El FGtJrv,Inc. NUERA Scottsdale InuraneCompar Insurance
<br /> 136 E Chapel Hill Street eraU, ;/LIBERTY MUTUAL INSURANCE jmm
<br /> Durham,NC 27701
<br /> i I NBURSR D
<br /> INSURER E:
<br /> IN91Rf_.
<br /> .OVER ._,...-�..«,,.�....._.,._ .,CERTIFICATE NUMBER
<br /> :a CERTIFICATE NUMBS REVISION NUMBER:
<br /> NOTWITHSTANDING RtAT E ANY RE-6F IN URA TERM OR _6W HAVE _N„i, UE „ INSURM H ICY RI
<br /> THIS IS Tq CERTIFY THAT THE POLICIES OF INSURANCE LIS'7ED BELOW HAWS BEEN ISSUED TO THE INSURED NAMLIJ�A8C3VE FOR THE PpLIC',Y P[RE�1C2
<br /> 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 /> INSRr ....;MrrDL ISUR __...,_._. — _proLferEIrP._.r'�1r P ,,. ,._.� ,.,.. _...—.—., ,��_,
<br /> Mm,µ TYPE OF INSURANCE e,S . � PO'LICYTiI'WAi�ER M_iMl'D 1 LNIA1Te
<br /> GENERAL LIABILITY
<br /> EACH OCCURRENCE S 1,600r00rl
<br /> A X COMMERCIAL GENERAL LtAeltlrY X ' CIPS001B8450 10)05/2016 10/05/2017 nr ETOTSEFI'rErr
<br /> l3 ^^�.S�L!dN_ r=" k �i 30000
<br /> J CU41MS�-IMDE X 'occuR i r+>ED 'P{Any one Ea w,2 s _.. '5,000{
<br /> � l PERSONAL a ADV INJURY s 1 000 000,
<br /> .. I GENERAL AGGREGATE s s oaa,MU 1,'
<br /> OEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS COMP/OP AGG S 3000 000`
<br /> ix I PCLICY.1_,im..Id;.1:;1L.-/---117PC .w.,._..� m_,.... � 7 I S
<br /> AUTOMOBILE LIABILITY T. COieNED SINGLE LIMIT S 1 000�00fl
<br /> AHY AUTO V I(Ea accident:
<br /> BODILY INJURY(Per pers0r4 S
<br /> ALL OWNED AUTOS . _IOOIL.._.,-.,.e_,_ -ST”— _..._. ......,,..,.
<br /> SCHEDULED AUTOS . — --?
<br /> BODILY INJURY(Purr aetMard,
<br /> PROPERTY DAMAGE - ,---
<br /> A 1 X HIRED AUTOS PS0058460 10/05/2016 10/0512017 IPERACCtDENTI
<br /> A X NON-OWNED AUTOS OPS0065460 10/05/2016 1010'5/2017 I s
<br /> II
<br /> Tri s
<br /> ' UMBRELLA UAB OCCUR EACH OCCURRENCE S
<br /> _ ffxcESa lue
<br /> CLAIMS-rtkADE AGGREGATE S
<br /> DEDUCTIBLE s
<br /> WORKERS C MPEWSAmf}N ._..._. M,_....,.... ..��,..._.-,._ .w,..M ..w.m.___.a_.._..., �VVC STA'TMI,.w 2- $ ..w
<br /> __RN,iE_NT „_„„
<br /> AND EMPLOYERS'UABK.JTY Y N �,Q¢yy�,ilr}ln�
<br /> B '.ANY PROPRIETORFPARTNERIEXECUTOVE El , C2441.435700-015 11/12120155 11/12/2016 EL EACHACCIDENT s ,.�,.m..,.1,000 000u
<br /> OFFIGERAIIENBER EXCLUDED? N T A I ,..._ ,._.._.,.,
<br /> 'IMandato.Y In MO E L DISEASE EA EMPLOYEE;i 1,000,000;
<br /> 14 yet,describe und el'
<br /> DESCRIPTION OF_gPERATIONTt bedew V 4 17�1SEASE.-POLICY LIMIT S.,,,_��1,Dd0, 0C
<br /> A iProfesslonalLiab I OPS0058480 1010512016110/05/2017 IlEa Claim —1,006,006
<br /> Claims Made �R ETRO 10105/05 1 Aggregate 3,000,0001
<br /> _ .. _..., A. _._.General Liability,but uI,If man up .. ._...� ,. .�......w.
<br /> DEED WPnON OF OPERATIONS F LOCATIONS I VEHICLES IMMO,ACORD 101,AdelMansl Remarks Soh_ _ _...o woos is reeturraiN ,.
<br /> Certificate holder is additional insured der a Gene ,
<br /> only with respects to operations of the Named Insured..
<br /> CERTIFIC1,T..'a a ..!..': CANCELLATI e'>)
<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 /> Attn:Finance Dept 1
<br /> 200 S Cameron Street AUTHORIZED aelsPRCaeNIAYnre
<br /> Pd}BOX 8181 1 House AccountlJoel T.Cheatham
<br /> Hillsboro,NC 27278
<br /> (D 1980-2009 ACORD CORPORATION. Ail rights reserved.
<br /> ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD
<br />
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