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DocuSign Envelope ID: 22DDA535- EA45- 448B- 9C14- 4375A5FBA8E3 <br />A °0 CERTIFICATE OF LIABILITY INSURANCE <br />DATElMlA1D[l,SWYI <br />071201'2(798 <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 BELOW. THIS <br />CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR <br />PRODUCER, AND THE CERTIFICATE HOLDER, <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(its) must have ADDITIONAL INSURED provisions or be endorsed. If <br />SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this <br />certificate does not confer rights to the certificate holder in lieu of such endorsement s , <br />PRODUCER <br />CONTACT I NT ©. A T EN <br />FEDERATED MUTUAL INSURANCE COMPANY <br />HOME OFFICE: P.O. BOX 328 <br />A CNNa Ext : 88$- 333 -4949 AX No : 507 -446 -4664 <br />AODREss:CLIENTCONTACTCENTER FEDINS.COM <br />OWATC7NNA, MN 55060 <br />INSURER(S) AFFORDING COVERAGE <br />NAM <br />EACH OCCURRENCE <br />INSURER A. FEDERATED MUTUAL INSURANCE COMPANY <br />13935 <br />PREMISE T Ea Oa TE Hence <br />INSURED 1i64- 640 -5 <br />INSURER S: <br />EXCLUDED <br />PROCTOR FLOORIN3 & ACOUSTICAL <br />INSURER C: <br />$1,000,QOO <br />110 BRENROSE CIR <br />INSURER D: <br />$2,000,000 <br />DURHAM, NC 27705 -2203 <br />INSURER E: <br />INSURER F: <br />AUTOMOBILE <br />X <br />LIABILITY <br />ANY AUTO <br />OWNED AUTOS ONLY SCHEDULED <br />AUTOS <br />HIRED AUTOS ONLY NON OWNED <br />AUTOS ONLY <br />COVERAGES CERTIFICATE NUMBER: 45 REVISION NUMBER: 0 <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 V1iTH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN lS SUBJECT TO ALL THE TERMS. EXCLUSIONS <br />AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />DL <br />INSR <br />SUER <br />POLICY NUMBER <br />POLICY EFF <br />MMfDDIYYYY <br />POLICY EXP <br />MMIDDNVYY <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAJMS -MADE OCCUR <br />Y <br />N <br />6069568 <br />07/0112018 <br />07/01/2019 <br />EACH OCCURRENCE <br />$1,DDD,D00 <br />GEN'L <br />X <br />PREMISE T Ea Oa TE Hence <br />$1D0,DDD <br />MED EXP (Any one person) <br />EXCLUDED <br />PERSONAL& ADV INJURY <br />$1,000,QOO <br />AGGREGATE UM17 APPLIES PER! <br />PO! -3CY ���ECT �LOC <br />OTHER: <br />GENERAL AGGREGATE <br />$2,000,000 <br />PRODUCTS - COMPIOP AC-0 <br />$2,000,000 <br />A <br />AUTOMOBILE <br />X <br />LIABILITY <br />ANY AUTO <br />OWNED AUTOS ONLY SCHEDULED <br />AUTOS <br />HIRED AUTOS ONLY NON OWNED <br />AUTOS ONLY <br />N <br />N <br />608 O 568 <br />071011201$ <br />07109/2019 <br />COMBINED SINGLE LIMIT <br />ya a lzr en <br />$9,QDQ,DDQ <br />BODILY INJURY {Per person)( <br />BODI LY INJURY (Per auident} <br />PROPERTY DAMAGE <br />Per acrid <br />A <br />X <br />UMBRELLA LIAR <br />EXCESS LIAR <br />X <br />OCCUR <br />I CLAIMS -MADE <br />N <br />N <br />6069570 <br />0710112098 <br />071D1/20 19 <br />EACH OCCURRENCE <br />SS,000;ODO <br />AGGREGATE <br />S5,OOO,000 <br />DED I I RETENTION <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' AR7NE I IE <br />ANY PROPRMBERYEXCLUDRJEXECUTIVE YIN <br />(Mandatory in NH EXCLUDED. <br />{Mandatory in NH) <br />If yes, describe Under <br />DESCRIPTION OF OPERATIONS below <br />N <br />5069569 <br />07/01/2018 <br />0710112019 <br />X <br />PER STATUTE <br />OTH- <br />ER <br />E.L EACH ACCIDENT <br />55DD,QDD <br />E.L. DISEASE - EA EMPLOYEE <br />E.L DISEASE - POLICY LIMIT <br />SsOD,DQD <br />DESCRIPTION OF OPERATIONS 1 LOCATIONS o VEHICLES (ACORD 101. Addiiianal Remarks Schedule. (nay he attadled if more space Is required) <br />PROJECT; 200 SOUTH CAMERON STREET. <br />THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS, LESSEES <br />OR (CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU ENDORSEMENT FOR GENERAL LIABILITY. <br />CERTIFICATE HOLDER CANCELLATION <br />I <br />64 -640 -5 <br />C]RAN3E COUNTY <br />PO BOX 8181 <br />HILLSBOROU3H, NC 272781$1 <br />450 <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 />AUTHORIZED REPRESENTATIVE _ <br />@ 1988 -2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />