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ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />INSR ADDLSUBR <br />LTR INSDWVD <br />DATE (MM/DD/YYYY) <br />PRODUCER CONTACTNAME: <br />FAXPHONE(A/C, No):(A/C, No, Ext): <br />E-MAILADDRESS: <br />INSURER A : <br />INSURED INSURER B : <br />INSURER C : <br />INSURER D : <br />INSURER E : <br />INSURER F : <br />POLICY NUMBER POLICY EFFPOLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) <br />AUTOMOBILE LIABILITY <br />UMBRELLA LIAB <br />EXCESS LIAB <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />AUTHORIZED REPRESENTATIVE <br />EACH OCCURRENCE$ <br />DAMAGE TO RENTEDCLAIMS-MADEOCCUR $PREMISES (Ea occurrence) <br />MED EXP (Any one person)$ <br />PERSONAL & ADV INJURY$ <br />GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ <br />PRO-POLICYLOC PRODUCTS - COMP/OP AGG$JECT <br />OTHER:$ <br />COMBINED SINGLE LIMIT $(Ea accident) <br />ANY AUTO BODILY INJURY (Per person)$ <br />OWNEDSCHEDULED BODILY INJURY (Per accident)$AUTOS ONLYAUTOS <br />HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLYAUTOS ONLY (Per accident) <br />$ <br />OCCUR EACH OCCURRENCE$ <br />CLAIMS-MADE AGGREGATE$ <br />DEDRETENTION$$ <br />PEROTH-STATUTEER <br />E.L. EACH ACCIDENT$ <br />E.L. DISEASE - EA EMPLOYEE$ <br />If yes, describe under E.L. DISEASE - POLICY LIMIT$DESCRIPTION OF OPERATIONS below <br />INSURER(S) AFFORDING COVERAGENAIC # <br />COMMERCIAL GENERAL LIABILITY <br />Y / N <br />N / A <br />(Mandatory in NH) <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <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 />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 />COVERAGESCERTIFICATE NUMBER:REVISION NUMBER: <br />CERTIFICATE HOLDERCANCELLATION <br />© 1988-2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03) <br />CERTIFICATE OF LIABILITY INSURANCE <br />LOCKTON COMPANIES <br />2100 ROSS AVENUE, SUITE 1400 <br />DALLAS TX 75201 <br />214-969-6700 <br />Door Services Corporation <br />dba Advanced Door Automation <br />PO Box 61678 <br />Durham NC 27715 <br />OVEDO01 <br />Mitsui Sumitomo Insurance USA Inc.22551 <br />Mitsui Sumitomo Insurance Co of America20362 <br />Aspen Specialty Insurance Company10717 <br />Allied World National Assurance Company10690 <br />X <br />X <br />XSIR applies per <br />policy terms & cond. <br />2,000,000 <br />1,000,000 <br />10,000 <br />2,000,000 <br />4,000,000 <br />4,000,000 <br />X <br />XX <br />1,000,000 <br />XXXXXXX <br />XXXXXXX <br />XXXXXXX <br />XXXXXXX <br />XX <br />X10,000 <br />10,000,000 <br />10,000,000 <br />XXXXXXX <br />N <br />X <br />1,000,000 <br />1,000,000 <br />1,000,000 <br />Excess Workers Comp.(OH, <br />WA) <br />Auto Buffer <br />WC Statutory Limits; 1M EL/Ea <br />Accident; 1M EL Disease Emp/Policy <br />1M per occurrence <br />ABVR 8406521 (AOS)10/1/201710/1/2018ABVM 8803088 (MA)10/1/201710/1/2018 <br />AGL 212248910/1/201710/1/2018 <br />BXWC 9800047 (OH, WA)7/1/20177/1/2018 <br />DCV006PW1710/1/201710/1/2018 <br />C0309-793710/1/201710/1/2018 <br />AWCP 9113272 (AOS)10/1/201710/1/2018 <br />7/1/2018 <br />1342188 <br />YN <br />NN <br />NN <br />N <br />9/18/2017 <br />NN <br />13473293 <br />13473293XXXXXXX <br />Orange County <br />PO Box 8181 <br />Hillsborough NC 27278 <br />X <br />ESENTATIVE <br />© 1988-2015 ACORD CORPORRRRRATIOOON. AlAAl <br />See Attachment <br />DocuSign Envelope ID: A96C6BF4-DA03-48F5-BEDB-D64EA1FEF830