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DocuSign Envelope ID:4D599C47-B969-42FC-9609-93615CD6F44A <br /> ACCU?a CE!°:TIFICATE OF LiA' '-ILITY "°„ S RA'' »CE DATE(MM/DD/YWY) <br /> 9/6/2017 <br /> THIS CERTIFICATE IS ISSUED AS A 1' ATTER OF I' FORMATIO?'n, ONLY ANI CONFERS NO RIGHTS UI ON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY •iR NEGATIVELY AMEND, EXTEND OR ALTE Ti E COVE? GE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT COPSTITUTE A CONTRACT BETWEEN THE ISSUING INSI.iRER(S), AUT'IIORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CE< TIFICATE HOLDER. <br /> II"POI-TANT: If the certificate holder is an ADDITIOI;AL INSU;' ED,the pol'Icy(ies)must have ADDITIONAL INSURED provisions or a endorsed. <br /> If SUB,OGATIOFd IS WAIVED, subject to the terms and conditions of the policy, certain policies may r&luire an endorsement. A statement on <br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT <br /> NAME: <br /> Knight I surance PHONE Ext): 919-245-1020 FAX Nm): 919-245-1010 <br /> 110 Boone Square Street, Suite 7 E-MAIL p�ni htunsurance ralei h.twcbc.corri <br /> Q ADDRESS: g <br /> HIIISborou h, ")C+ 2727k INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A: Utica National Insurance Gro <br /> INSURER B <br /> Howard Cecil INSURER C <br /> 3223 Forrest Ave INSURER D: <br /> Eflan , NC 27243 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 INS°SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS <br /> (MM/DD/YVYY) (MMIDD/YYYY) <br /> A COMMERCIAL GENERAL LIABILITY 5074025 09/05/17 09/05/18 EACH OCCURRENCE $ 1,000,00f <br /> CLAIMS-MADE X. OCCUR DAMAGE TO RENTED <br /> PREMISES I E l(Ea occurrence) $ 50,000 <br /> MED EXP(Any one person) $ 10,000 <br /> PERSONAL&ADV INJURY $ <br /> GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> POLICY PRO- <br /> JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> (Ea accident) <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 /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER <br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBEREXCLUDED? N/A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under '.. <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ '.. <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 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> PO Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Hillsborough, NC 27278 <br /> AUTHORIZED REPRESENTATIVE <br /> c <br /> ;' X r .a fi....� <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />