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DocuSign Envelope ID:C2500EBD-6FF9-4A09-9D2D-AA4443F63583 <br /> AC©RDe CERTIFICATE OF LIABILITY INSURANCE DATE(MMrDDIYYYY) <br /> 10/23/2017 <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 Sam <br /> NAME: <br /> Triad Insurance Associates <br /> PHONE <br /> .Ext): FAX <br /> .No): (919)663-0454 <br /> 112 South Chatham Avenue E-MAIL <br /> ADDRESS: <br /> PO Box 512 INSURER(S)AFFORDING COVERAGE NAIC B <br /> Siler City NC 27344 INSURERA Evanston Insurance Company 00000 <br /> INSURED INSURER B Mesa Underwriters Specialty <br /> Wayne Oldham&Son House Moving INSURER C <br /> 12901 Siler City-Glendon Rd. INSURER 0 <br /> INSURER E <br /> Bear Creek NC 27207 _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 ADDL SUER POLICY EFF POLICY EXP LIMITS <br /> LTR INSD WVr) POLICY NUMBER (MM.'DD!YYYY) (MMtDD!YYYY) <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> DAMAGE RENTED <br /> CLAIMS-MADE OCCUR PREMISES O(Ea occurrence) $ 100,000 <br /> MED EXP(Any one person) $ 5,000 <br /> A N N IMS38230 08/29/2017 08/29/2018 PERSONAL&ADVINJURY $ 1,000,000 <br /> GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> POLICY PRO-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 STATUTE ER <br /> YIN <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E .EACH ACCIDENT $ <br /> OFFICERIMEMBER EXCLUDED? N/A <br /> (Mandatory in NH) E .DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E .DISEASE-POLICY LIMIT $ <br /> Cargo 100,000 <br /> B N N IM538230 08/29/2017 08/29/2018 <br /> DESCRIPTION OF OPERATIONS LOCATIONS,VEHICLES (ACORD 101;Additional Remarks Schedule,may be attached if more space is required) <br /> house mover <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 <br /> AUTHORIZED REPRESENTATIVE <br /> I Hillsborough NC 27278 _ <br /> Fax: Email:jethompson@aorangecountync.gov © 1988-2015ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />