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DocuSign Envelope ID: F3C7762A- 23A9- 4B50- BCBB- 793718768C3A
<br />X411 , CERTIFICATE OF LI
<br />TH15 CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONL
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITU
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL_ INSURED, the
<br />the terms and conditions of the policy, certain ,policies may require an e
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />MILLER INSURANCE AGENCY
<br />P O BOX 390
<br />WEST JEFFERSON, NC 28694
<br />INSURED
<br />VEHICLES INC
<br />P 0 BOX 790
<br />JEFFERSON, NC 28640
<br />OP ID: LS
<br />ABILITY I N 5 U RA N C E DATE (MMMDDrrvvv)
<br />0412012018
<br />Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />TE A CONTRACT BETWEEN THE ISSUING INSURERIS), AUTHORIZED
<br />policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />ndorsement. A statement on this certificate does not confer rights to the
<br />CONTACT
<br />NAME: Lewis W Shepherd
<br />PHONE
<br />Ex : 336 -246 -7151
<br />E-MAIL FAX No): 336 - 246 -5138
<br />lewisSmillerinsurance.org
<br />nce.o
<br />SO ER
<br />CU NORTEM1
<br />CUSTOMER IO #:
<br />INSURERS AFFORDING COVERAGE NAIC #
<br />INSURERA: EMPLOYERS MUTUAL INS CO
<br />INSURER 6:
<br />INSURER C ;
<br />INSURER D;
<br />[INSURER E SURER F :
<br />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
<br />LTR TYPE OF INSURANCE. FNRR POLICY NUMBER MWDCDrfYYY (MM bCDNYYY LIMITS
<br />WVD GENERAL LIABILITY
<br />EACH OCCURRENCE 1,0001.00
<br />A X COMMERCIAL GENERAL LIABILITY 2D2-d5 -21 -19 04/2712018 04127/2019 PREMISES Ea occurrence $ 300,00
<br />ErCLAIMS -MADE 7x MED EXP (Any one person) $ 5,00
<br />PERSONAL & ADV INJURY $ 1,000,00
<br />GENERAL AGGREGATE $ 2,000,00
<br />GENT AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG $ 2,000,00
<br />X POLICY PRO- LOC
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br />A X ANY AUTO 2E245 -21 -19 04/2712018 CW2712019 (Ea accident) $ 1,000,00
<br />ALL OWNED AUTOS BODILY INJURY (Per Person) $
<br />SCHEDULED AUTOS
<br />BODILY INJURY (Per accident) $
<br />PROPERTY DAMAGE
<br />HIRED AUTOS $
<br />(PER ACCIDENT)
<br />NON -OWNED AUTOS GARAGE $ 1,000,00
<br />A X GARAGE LIABILITY 2E2- 45 -21 -19 [1412712018 04!2712019 GARAGE AGG s 3,000,00
<br />UMBRELLA LIAe X OCCUR EACH OCCURRENCE S 51000,00
<br />EXCESS LIAR CLAIMS -MADE
<br />A 2J2- 45-21 -19 04127/2018 04/27/2019 AGGREGATE $ 5,000,00
<br />DEDUCTIBLE $
<br />X RETENTION $ 10,000
<br />$
<br />AND EMPLOYERS' COMPENSATION LIABILITY A ILIT YIN WC TATT X O R
<br />AND EMPLOYERS' LIABILITY
<br />A OPRCERIMEMBERrEXCLUDED ?ECUTIVE ❑ NIA 2H2- 45 -21 -19 041271201$ 0 412 712 0 1$ E,L. EACH ACCIDENT $ 500,00
<br />(Mandatory In an
<br />If describe under E.L. DISEASE - EA EMPLOYEE S 500,00(
<br />y9s,
<br />DESCRIPTION OF OPERATIONS below E L. DISEASE - POLICY LIMIT $ 500,00
<br />• 1PHYSICIAL DAMAGE 2E2A5 -21 -19 04127/2018 04/2712019 DEALER PH 400,00
<br />• IGARAGE KEEPERS 11 2E2- 45 -21 -18 04127120'18 04127!2019 GARAGE KE 400,00
<br />DESCRIPTION OF OPERATIONS LOCATIONS 7 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required)
<br />CERTIFICATE HOLDER CANCELLATION
<br />ORANGEC
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />ORANGE COUNTY THE EXPIRATION 'DATE THEREOF, NOTICE WILL BE DELI RED IN
<br />PO BOX 8181 ACCORDANCE WITH THE POLICY PROVISIONS,
<br />HILLSBOROUGH„ NC 27278 -
<br />AUTHO D REPRESENTATIVE
<br />e
<br />0 1988 -2009 ACORD dORPORATIQ . All rights reserved.
<br />ACORD 25 (2009109) The ACORD name and logo are registelred marks of ACORD
<br />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
<br />LTR TYPE OF INSURANCE. FNRR POLICY NUMBER MWDCDrfYYY (MM bCDNYYY LIMITS
<br />WVD GENERAL LIABILITY
<br />EACH OCCURRENCE 1,0001.00
<br />A X COMMERCIAL GENERAL LIABILITY 2D2-d5 -21 -19 04/2712018 04127/2019 PREMISES Ea occurrence $ 300,00
<br />ErCLAIMS -MADE 7x MED EXP (Any one person) $ 5,00
<br />PERSONAL & ADV INJURY $ 1,000,00
<br />GENERAL AGGREGATE $ 2,000,00
<br />GENT AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG $ 2,000,00
<br />X POLICY PRO- LOC
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br />A X ANY AUTO 2E245 -21 -19 04/2712018 CW2712019 (Ea accident) $ 1,000,00
<br />ALL OWNED AUTOS BODILY INJURY (Per Person) $
<br />SCHEDULED AUTOS
<br />BODILY INJURY (Per accident) $
<br />PROPERTY DAMAGE
<br />HIRED AUTOS $
<br />(PER ACCIDENT)
<br />NON -OWNED AUTOS GARAGE $ 1,000,00
<br />A X GARAGE LIABILITY 2E2- 45 -21 -19 [1412712018 04!2712019 GARAGE AGG s 3,000,00
<br />UMBRELLA LIAe X OCCUR EACH OCCURRENCE S 51000,00
<br />EXCESS LIAR CLAIMS -MADE
<br />A 2J2- 45-21 -19 04127/2018 04/27/2019 AGGREGATE $ 5,000,00
<br />DEDUCTIBLE $
<br />X RETENTION $ 10,000
<br />$
<br />AND EMPLOYERS' COMPENSATION LIABILITY A ILIT YIN WC TATT X O R
<br />AND EMPLOYERS' LIABILITY
<br />A OPRCERIMEMBERrEXCLUDED ?ECUTIVE ❑ NIA 2H2- 45 -21 -19 041271201$ 0 412 712 0 1$ E,L. EACH ACCIDENT $ 500,00
<br />(Mandatory In an
<br />If describe under E.L. DISEASE - EA EMPLOYEE S 500,00(
<br />y9s,
<br />DESCRIPTION OF OPERATIONS below E L. DISEASE - POLICY LIMIT $ 500,00
<br />• 1PHYSICIAL DAMAGE 2E2A5 -21 -19 04127/2018 04/2712019 DEALER PH 400,00
<br />• IGARAGE KEEPERS 11 2E2- 45 -21 -18 04127120'18 04127!2019 GARAGE KE 400,00
<br />DESCRIPTION OF OPERATIONS LOCATIONS 7 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required)
<br />CERTIFICATE HOLDER CANCELLATION
<br />ORANGEC
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />ORANGE COUNTY THE EXPIRATION 'DATE THEREOF, NOTICE WILL BE DELI RED IN
<br />PO BOX 8181 ACCORDANCE WITH THE POLICY PROVISIONS,
<br />HILLSBOROUGH„ NC 27278 -
<br />AUTHO D REPRESENTATIVE
<br />e
<br />0 1988 -2009 ACORD dORPORATIQ . All rights reserved.
<br />ACORD 25 (2009109) The ACORD name and logo are registelred marks of ACORD
<br />
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