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DocuSign Envelope ID:87297174-8311-443E-8424-CD9AE774C78C <br /> T <br /> ACGREr CERTIFICATE OF LIABILITY INSURANCE DATE IMM/DDY YY) <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 pollcy(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 (704)542-5481 NAME:°ACT Hugh L Kluttz Jr <br /> Carmel Commons Insurance Agency PHONE FAX <br /> IANC.No.Eat):(704)542-5481 Ext. (A/c,No): (704)544-0364 <br /> E-MAIL <br /> 6404 Carmel Rd, Suite 204 ADDRESS: <br /> Charlotte, NC 28226 INSURER(S)AFFORDING COVERAGE NAIC It <br /> INSURER A:AUTO OWNERS INSURANCE COMPANY 18988 <br /> INSURED APPLIED DRIVES INC INSURER B: <br /> 11016 TARA OAKS DRIVE INSURERC: <br /> CHARLOTTE, NC 28227 INSURER D: <br /> (704)573-2324 Ext. INSURERE: <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 /> ILTR TYPE OF INSURANCE INSR SUM WI POLICY NUMBER POLICY YY POLICY EXP LIMITS <br /> {MMIDD/YYYY) (MMlDD/YYYY) <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> DAMAGE l RENTED <br /> X COMMERCIAL GENERAL LIABILITY <br /> PREMISES{Ea occurrence) $ 300 000 <br /> CLA1MS-MADE X ,OCCUR MED EXP(Any one person) $ 10,000 <br /> A Y 014615-35025925-17 08/01/17 08/01/18 PERSONAL&ADVINJURY $ 1,000,000 <br /> i GENERAL AGGREGATE $ 2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> O <br /> —1 POLICY <br /> CT n LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> (Ea accident) $ 1,000,000 <br /> 1 <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> A AUTOS AUTOS Y 014615-35025925-17 08/01/17 08/01/18 PROPERTY DAMAGE $ <br /> X HIRED AUTOS A AUTOS (Per accident) <br /> $ <br /> X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 5,000,000 <br /> A EXCESS LIAB CLAIMS-MADE 42-840-297-00 07/01/17 07/01/18 AGGREGATE $ 5,000 000 <br /> DEC X RETENTION$ 10,000 $ <br /> WORKERS COMPENSATION WC STATU- ( OTH-' <br /> AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ,_ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE EL.EACH ACCIDENT $ 1,000,000 <br /> A OFFICEFVMEMBEREXCLUDED7 NIA }( 031715 35014522 08/01/17 08/01/18 <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 <br /> It yes,descnbe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,It more space Is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> ORANGE COUNTY ASSET MANAGEMENT SERVICES <br /> Allison COOper , SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> , THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN <br /> acooper@orangecountync.gov ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZ D REPRESENTATIVE <br /> I /0/ <br /> ®1988-2010 ACO TJ CORPORATION. All rights reserved. <br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD <br />