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DocuSign Envelope ID:B24B6EE8-440A-4618-BA1B-758A520A23BC <br /> AC?J CERTIFICATE OF LIABILITY INSURANCE <br /> DATE(MM/DD/YYYY) <br /> ' 6/28/2017 <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 Aon Risk Services Northeast, Inc. NAME:ACT A.I. King Insurance Agency,Inc. <br /> 1660 W. 2nd Street, Suite 650 PHONE FAX <br /> Cleveland, OH 44113 Ext): <br /> E-MAIL 317-841-6004 (A/C,No): 317-841-6006 <br /> E-MAIL L <br /> ADDRESS: richard@aikinginsurance.com <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURERA: Old Republic Insurance Company 24147 <br /> INSURED INSURER B: Lexington Insurance Company 19437 <br /> Cummins Inc. <br /> 500 Jackson Street INSURER c: Ace American Insurance Company 22667 <br /> Mail Code 60805 INSURERD: <br /> Columbus IN 47201-6258 INSURERE: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 36405340 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 EFF POLICY EXP LIMITS <br /> LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) <br /> A / COMMERCIAL GENERAL LIABILITY ✓ MWZY 302202-16 12/1/2016 12/1/2017 EACH OCCURRENCE $ 1,000,000 <br /> DAMAGE TO CLAIMS-MADE ,/ OCCUR PREMISES(Ea occur ence ) $ 1,000,000 <br /> MED EXP(Any one person) $ 10,000 <br /> PERSONAL&ADVINJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> ✓ POLICY JECT PRO LOC PRODUCTS-COMP/OPAGG $ 2,000,000 <br /> OTHER: $ <br /> A AUTOMOBILELIABILITY MWTB 12/1/2016 12/1/2017 COMBINED SINGLE LIMIT $ <br /> ✓ (Ea accident) 2,000,000 <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> ✓ AUTOS ONLY ✓ AUTOS ONLY (Per accident) <br /> ✓ Phy Damage <br /> $ Self Insured <br /> B 7 UMBRELLA LIAB / OCCUR 62785312 12/1/2016 12/1/2017 EACH OCCURRENCE $ 10,000,000 <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000 <br /> DED RETENTION$ $ <br /> A WORKERS COMPENSATION / MWC 308551 00 12/1/2016 12/1/2017 ✓ O <br /> PERTUTE ETH <br /> AND EMPLOYERS'LIABILITY <br /> Y N <br /> ANYPR PRIETOREXCLUDEE ECUTIVE N N/A E.L.EACH ACCIDENT $ 1,000,000 <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 <br /> C Property FAZD38483018 8/1/2016 8/1/2017 Limit:$10,000,000 <br /> Special Form including Earthquake&Flood <br /> Leased/Rented Equipment FAZD38483018 8/1/2016 8/1/2017 Limit:$25,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> Orange County NC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> g Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> PO Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 200 S. Cameron St. <br /> Hillsborough NC 27278 <br /> AUTHORIZED REPRESENTATIVE <br /> er <br /> / /c <br /> Richard Trakimas <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br /> 36405340 1 16/17 GL AU OMB WC 16/17 PROP (Std-Merged Dist) I Kaleeda Jenkins 1 6/28/2017 1:18:20 PM (PDT) I Page 1 of 1 <br />