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DocuSign Envelope ID: 3DA3CD72-390C-4765-969A-9FC5040C04E7 <br /> qC�® DATE(MMIDD/YYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE 8/25/2017 <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 be endorsed. If SUBROGATION IS WAIVED,subject to <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 /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER NAMEACT Heidi Morse <br /> Jones Insurance Agency Inc. PHONE 919-772-0233 FAX <br /> 919-779-4025 <br /> 820 Benson Road (arc,No,Ext): (A/C.No): <br /> Garner NC 27529 _ADDRLESS heidim@jones-insurance.com <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A:Auto Owners Insurance Company 18988 <br /> INSURED NWPOOLE-01 INSURER B:Owners Insurance Company 32700 <br /> Letco Inc dba N W Poole Well&Pump Co INSURER c:Accident Fund Ins Co of Amer 10166 <br /> P.O. Box 1958 <br /> Wendell NC 27591 INSURER D: <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:6209408 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 /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YYYY) (MMIDD/YYYY) LIMITS <br /> A x j COMMERCIAL GENERAL LIABILITY Y 35281356 7/1/2017 7/1/2018 EACH OCCURRENCE $1,000,000 <br /> DAMAGE TO RENTED <br /> CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $300,000 <br /> MED EXP(Any one person) $10,000 <br /> PERSONAL&ADV INJURY $1,000,000 <br /> GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 <br /> POLICY X JE LOC PRODUCTS-COMP/OP AGG $2,000,000 <br /> OTHER: $ <br /> B AUTOMOBILE LIABILITY Y 51-28135601 7/1/2017 7/1/2018 COMBINED SINGLE LIMIT $ <br /> (Ea accident) 1,000,000 <br /> X I ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED ■ SCHEDULED BODILY INJURY(Per accident) $ <br /> NON-OWNED PROPERTY DAMAGE <br /> X HIRED AUTOS AUTOS <br /> © AUTOS (Per accident) <br /> $ <br /> B X UMBRELLA LIAB X OCCUR 51-28135600 7/1/2017 7/1/2018 EACH OCCURRENCE $2,000,000 <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $2,000,000 <br /> DED X RETENTION 510,000 $ <br /> C WORKERS COMPENSATION WCV6130199 7/1/2017 7/1/2018 PER <br /> AND EMPLOYERS'LIABILITY X STATUTE ER OTH- <br /> Y/N <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE N NIA E.L.EACH ACCIDENT $500,000 <br /> OFFICER/MEMBER EXCLUDED? <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 <br /> It yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 <br /> A Installation Floater 35281356 7/1/2017 7/1/2018 Installation Limit 150,000 <br /> Leased/Rented Equipment Leased/Rented 100,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> •The General Liability policy includes blanket additional insured endorsement that provides additional insured status for ongoing operations <br /> and products and completed operations and a blanket waiver of subrogation endorsement that provides waiver of subrogation status to the <br /> certificate holder and other entities when there is a written"insured contract"between named insured and certificate holder that requires such <br /> status. •The General Liability policy contains a blanket endorsement providing primary and non-contributory status when a written"insured <br /> contract"requires such status. <br /> •The Auto Liability policy includes a blanket additional insured endorsement that provides additional insured status and blanket waiver of <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 /> P.O.Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Hillsborough NC 27278 <br /> 4a.RIZEDREPRESENTATIVE <br /> I <br /> / M 0/ . <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br />