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DocuSign Envelope ID: 1 D5BBB55-D588-451 F-B00E-C60D100758CE <br /> DATE(MM/DD/YYYY) <br /> �L Rte® CERTIFICATE OF LIABILITY INSURANCE 3/13/2017 <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 CONTACT <br /> NAME: Mike Cox <br /> MIKE COX INSURANCE SERVICES (A/C No,Ext): 3363751313 I FAX No): <br /> E-MAIL <br /> 342 HILL ST ADDRESS: mikecox @triad.rr.com <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> ASHEBORO NC 27203 INSURER A: SOUTHERN INS CO OF VA 26867 <br /> INSURED INSURER B: SOUTHERN INS CO OF VA 26867 <br /> Carolina Awning INSURER C: <br /> Fabricators LLC INSURER D: <br /> Po Box 512 INSURER E: <br /> Seagrove NC 27341-0512 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 AUUL DUCK POLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1000000 <br /> UHIVIHI,t I U KEN I tU <br /> CLAIMS-MADE El OCCUR PREMISES(Ea occurrence) $ 100000 <br /> MED EXP(Any one person) $ 5000 <br /> A CPS8883180 10/25/2016 10/25/2017 PERSONAL a ADV INJURY $ 1000000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2000000 <br /> POLICY n FELT n LOC PRODUCTS-COMP/OP AGG $ 2000000 <br /> OTHER: PRDCO $ <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 PROPER IY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY (Per accident) <br /> $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED I I RETENTION$ $ <br /> WORKERS COMPENSATION I PER I OTH- <br /> AND EMPLOYERS'LIABILITY STATUTE ER <br /> B OFFICER/MEMBER/EXCLUDED?PROPRIETOR/PARTNER/EXECUTIVE Y^ N/A E.L.EACH ACCIDENT $ 100000 <br /> (Mandatory in NH) I I VCS 8673867 10/26/2016 10/26/2017 E.L.DISEASE-EA EMPLOYEE $ 100000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN <br /> ORANGE COUNTY ACCORDANCE WITH THE POLICY PROVISIONS. <br /> PO BOX 8181 AUTHORIZED REPRESENTATIVE <br /> HILLSBORO,NC 27278 I COX <br /> 1 <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />