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DocuSign Envelope ID: 89671D249- 04494C917- 8666- 178BEAll 741 F74
<br />Clilent #. 25609
<br />PENTENGI
<br />ACORD. CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMIDDIYYYY)
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />10104/2017
<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 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
<br />CONTACT
<br />NAME: Katie Kresner
<br />Greyling Ins. BrokeragetEPIC
<br />PHONE FAX
<br />Arc Ne pct : 770.552.4225 pIC, Noy: 866.550.4082
<br />3780 Mansell Road, Suite 370
<br />n uL , ICatie,Kresner@greyling , com
<br />Alpharetta, GA 30022
<br />$
<br />C
<br />INSURERS AFFORDING COVERAGE NAIC#
<br />INSURER A: Nautilus Insurance Company
<br />17370
<br />INSURED
<br />INSURER a: Great Divide Insurance Company
<br />25224
<br />PENTA Engineering Group, Inc.
<br />INSURER C: Ohio Securit Insurance Company
<br />2482
<br />4000 Miller Court West
<br />$
<br />Norcross, GA 30071
<br />INSURER D:
<br />INSURER E
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />NON•OWNEII
<br />HIRED AUTOS X AUTOS
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 17 -18 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 CONTRACTOR 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.
<br />LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS..
<br />INSR TYPE of INSURANCE ADD L SUBR
<br />LTR p
<br />-------------- ---- - - - - -- --- —
<br />- -- - POLICY EFF POLICY EXP LlAln'S
<br />_ PCLICYNUMBER MN11fD MMIDDNYYY
<br />A X COMMERCIAL GENERAL LIABILITY
<br />ECP201603712 0108/2017 1010812018 EACH OCCURRENCE $1,000,000
<br />CLAIMS -MADE I X I OCCUR
<br />. _.
<br />DAMA E 7 RENTEQ
<br />PREMISES Ea aocurcence $100 000
<br />_
<br />MED EXP (Any one person) $ 5,000
<br />PERSONAL A ADV INJURY $1,000,000
<br />n N'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY I^J JECT El LOC
<br />iGENERAL AGGREGATE s2,000,000
<br />PRODUCTS - COMPIOP AGG s2000000
<br />OTHER:
<br />$
<br />C
<br />AUTOMOBILE
<br />LIABILITY
<br />IBASI SS8312554
<br />10108/2017
<br />10/0812010
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />NON•OWNEII
<br />HIRED AUTOS X AUTOS
<br />X
<br />BODILY INJURY [Per accidenfj
<br />$
<br />X
<br />PROPERTY DAMAGE
<br />FFX201603812
<br />10108/2017
<br />EACH OCCURRENCE
<br />A
<br />UMBRELLA LIAR
<br />OCCUR
<br />1010812018
<br />$5.000.000
<br />X(
<br />$5,000,000
<br />I EXCESS LIAR
<br />X CLAIMS -MADE
<br />OED I X I RETENTION 0
<br />_AGGREGATE
<br />$
<br />E
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETORMARTNEWEXECUTIVE
<br />OFFICERIMEMBER EXCLUDED? ®
<br />N/A
<br />_
<br />WCA201603612
<br />0/08/20171n1n8I2n1
<br />_
<br />X PER OTH-
<br />STAT
<br />E.L. EACH ACCIDENT
<br />[s 000 000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$1,000,000
<br />(Mandatory In NH)
<br />0 yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />$1 ,000.,000
<br />E.L. DISEASE - POLICY LIMIT
<br />A
<br />Professional Liab
<br />ECP201603712
<br />1010812017
<br />10/08/201 Per Claim /Agg $IM/$2M
<br />Contractors Poll.
<br />ECP201603712
<br />10/0812017
<br />1010812018, PerCondition $1,000,000
<br />ILiability
<br />Aggregate $2,000,000
<br />DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mare space is required)
<br />Excess Liability includes Professional Liability,
<br />Contractors Pollution Liability, and CGL. Professional
<br />Liability in primary and Excess policies is claims -made. Aggregate Limits of $2,000,000 in primary CGL, PL
<br />and CPL applies to all three coverage parts. Aggregate limit of $5,000,000 in Excess Liability applies to
<br />CGL, PL and CPL.
<br />LM,1al.101:4RW-'t11019
<br />Orange County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />PO Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Hillsborough, NC 27278
<br />AUTHORIZED REPRESENTATIVE
<br />D 1988 -2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) 1 of 1 The ACORD name and logo are registered marks of ACORD
<br />#S872018IM871590 KKRE1
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