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DocuSign Envelope ID: 3038F92E-742A-4AA4-BDCE-980F4D400885 <br /> r.—..,� FIRESAF-04 LALLRED <br /> A "Rcr CERTIFICATE OF LIABILITY INSURANCE DATE`MMIDD/YYYY) <br /> 10/30!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 <br /> License#1000009384 cONrACT Lori <br /> NAME: Allred <br /> Hub International Southeast PHONE FAx <br /> PO Box 939 (A/C,No,Ext):{336)494-2525 wc,No):(336)226-6772 <br /> Burlington,NC 27216 Hass,lori,allred @hubinternational.com <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> _ INSURERA:AmGuard Insurance Company 42390 <br /> INSURED INSURER 9: <br /> Fire Safe Chimney Sweep INSURER C: <br /> — <br /> 4127 Hidden View Drive INSURER D: <br /> Mebane,NC 27302 <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LIS I ED 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 ISSUBJECTTO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS <br /> I.TR INSD tNVD (MMIDD/YYYY) IMMIDD(YYYYI <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE '$ <br /> CLAIMS-MADE I I OCCUR PREMISES(Eaoccurrence) ,$ <br /> ■ <br /> ■ <br /> MED EXP(Anyone person) $ <br /> PERSONAL.BADVINJURY $ _ <br /> GE 'L AGGRE ATE LIMIT APPLIES PER: GENERAL AGGREGATE $ I <br /> POLICY LOG PRODUCTS-COMP/OP AGG 1 _- <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY (Ea BBlddeDp SINGLE LIMIT $ <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> AUTOS ONLY SCHEDULED BODILY INJURY(Per sodden!) $ <br /> AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE <br /> (PerPERTY) $ <br /> S <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTIONS $ <br /> A AND EMPLOYERS COMPENSATION STATUTE I ERH <br /> Y/N R2WC816318 04/2212017 04/22/2018 100,000 <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT 5 <br /> FFIC RIM MBER EXCLUDED? 100,000 <br /> y <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If OF OPERATIONS below ������� <br /> E.L,DISFASE-POLICY LIMIT $ <br /> !!I <br /> T <br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) 3 <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 /> 200 Cameron Street <br /> Hillsborough,NC 27278 <br /> AUTHORIZED REPRESENTATIVE <br /> ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />