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DocuSign Envelope ID: 1EC07D09- 7E52- 4B20- AF64- 53C8794B18CF <br />ATLAWIL -01 AFOX <br />A R ®� CERTIFICATE OF LIABILITY INSURANCE 00211 12018 <br />02/1612418 <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 INSURER 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 CT <br />Iris Fox Insurance CD (AIIC, PHONE Ext : {828] 438 -432'1 0 -_.__ � Nea.(828) 433 -7636 <br />103 Carbon City Rd. <br />Morganton, NC 28655 EoD'iiss: irisfoxinsurance @gmaii.com <br />_ INSU <br />INSURED INSU <br />Atlantic Wildfire Resources LLC INSU <br />629 Smothers Rd INSU <br />Madlson, NC 27025 <br />F: <br />r- nwrrQArnr_c r' =0 r101f'ATC R31IRADCb. <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURE=D 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 <br />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 SUBR POLICY NUMBER PO olpY EFF POLICY EXP <br />A X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE ® OCCUR MWPK07679901 08126/2017 08/26/2018 <br />LIMITS <br />EACHOCCURRENCE 1,000,000 <br />DAMAGETaRENTED 10,000 MIS <br />PRE E <br />MED EXP (Anyone rson <br />10,000 <br />PERSONAL & ADV INJURY <br />1,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY El 9 LOC <br />GENERAL AGGREGATE <br />PRODUCTS - COMPIOP AGG <br />2,000,000 <br />2,000,000 <br />OTHER: <br />AUTOMOBILE <br />LIA13ILITY <br />y <br />COMBINED SINGLE LIMIT <br />Ma =!dent <br />BODILY INJURY Per meson <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY Per accklent <br />40.P Rdel AMAGE <br />yyNEp <br />AUTOS ONLY ZOVC S Oh1LY <br />A <br />UMBRELLA LIAR <br />X <br />OCCUR <br />EACH OCCURRENCE <br />4,000,000 <br />X <br />AGGREGATE <br />EXCESS LIAB <br />CLAIMS -MADE <br />CX DS 010908 <br />08/26/2017 <br />08/26/2018 <br />I5E0 RETENTIONS <br />_ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETORIPARTNER/EXECUTIVE J�`I <br />QFFICafUMFIMBER EXCLUDED? u <br />{{Magda cry n NHH} <br />If Yss describe under <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />PER OTH- <br />T <br />E.L. F4CHACCIDENT <br />E.L. DISEASE - EA EMPLOYE <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />DESCRIPTION Of OPERATIONS 1 LOCATIONS I VEHICLES ACORD 101, Additional Remarks Schedule, may be attached If more space is required) <br />Works ordered Blackwood Farm Park, 4215 NC 86, Chapel Hill, NC 27514 <br />1a <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Blackwood Farm Park <br />Blackwood <br />8181 West Tryon St ACCORDANCE WITH THE POLICY PROVISIONS. <br />Hillsborough, NG 27278 <br />AUTHORIZED REPRESENTATIVE <br />J-.7, <br />ACORD 25 (2015103) a 1988 -2015 ACORD CORPORATION. All rights reserved <br />The ACORD name and logo are registered marks of ACORD <br />