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DocuSign Envelope ID: 57E297CC-03C0-463C-B17A-569B0EAC735F
<br /> A CERTIFICATE OF LIABILITY INSURANCE M/°D/YYYY)
<br /> 7/224/204/2017
<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 /> CONT
<br /> PRODUCER NAMEACT Tiffany Davenport
<br /> BB&T Insurance Services, Inc. PHONE 804-678-5027 FAX 888-751-3010
<br /> 2108 W. Laburnum Ave Suite 300 (A/C,No,Fat). (A/C,No):
<br /> PO Box 17370 E-MAIL
<br /> ADDRESS:tdavenport@bbandt.com
<br /> ort@/�bbandt.com
<br /> Richmond VA 23227 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURER A:Valley Forge Insurance Company 20508
<br /> INSURED 35SMEINC INSURER B:Continental Insurance Company 35289
<br /> S&ME Inc. INSURER c:Travelers Property Casualty Co of Amer 25674
<br /> 3201 Spring Forest Rd. INSURER D:American Casualty Co of Reading PA 20427
<br /> Raleigh, NC 27616
<br /> INSURER E:XL Specialty Insurance Company 37885
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 101779072 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 ADDL SUER POLICY EFF POLICY EXP
<br /> TYPE OF INSURANCE '..
<br /> LTR INSD WVD POLICY NUMBER (MM/DDIYYYY) (MM/DD/YYYY) LIMITS
<br /> A x COMMERCIAL GENERAL LIABILITY Y Y 6042844344 7/1/2017 7/1/2018 EACH OCCURRENCE $1,000,000
<br /> DAMAGE RENTE
<br /> CLAIMS-MADE X OCCUR PREMISES O(Ea occurrence) $1,000,000
<br /> MED EXP(Any one person) $15,000
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> POLICY X 123 X LOC PRODUCTS-COMP/OPAGG $2,000,000
<br /> OTHER: $
<br /> B AUTOMOBILE LIABILITY Y Y 6042844313 7/1/2017 7/1/2018 COMBINED MINED)accident) LIMIT $1 000,000
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> X AUTOS ONLY X NON-OWNED ONLY (Per accident DAMAGE $
<br /> C X UMBRELLA LIAB X OCCUR Y Y ZUP51M6239517 7/1/2017 7/1/2018 EACH OCCURRENCE $5,000,000
<br /> EXCESS LIAB CLAIMS-MADE _AGGREGATE $5,000,000
<br /> DED X RETENTION$10,000 $
<br /> D WORKERS COMPENSATION Y WC642647965 7/1/2017 7/1/2018 X PER
<br /> OTH-
<br /> AND EMPLOYERS'LIABILITY STATUTE ER
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $1,000,000
<br /> OFFICER/MEMBER EXCLUDED? Y N/A
<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 /> E Professional Liability DPR9915178 7/1/2017 7/1/2018 5,000,000
<br /> including Pollution 5,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Umbrella policy extends over General Liability,Automobile Liability and Employers' Liability coverages.
<br /> In the event that the Company cancels the General Liability, Automobile Liability or Employers' Liability policies for any statutorily permitted
<br /> reason other than non-payment of premium,the Company agrees to provide ninety(90)days notice of cancellation of the Policy to any entity
<br /> with Whom the NAMED INSURED agreed in a written contract or agreement would be provided with notice of cancellation of the policy.
<br /> See Attached...
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Dept.of Environment,Agriculture,Parks and Recre ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Attn:Thomas Davis
<br /> 306 A Revere Road
<br /> PO Box 8181 AUTHORIZED REPRESENTATIVE
<br /> Hillsborough NC 27278 le.0:E5612440"t4i44.04......k....
<br /> I
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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