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DocuSign Envelope ID: 3EFOFF2D- AE78- 42B5- B6CA- 82C9778lC16E
<br />Client#: 25609
<br />PFAJTFNr.1
<br />ACORD. CERTIFICATE OF LIABILITY INSURANCE D101041DDfY7
<br />1010412017
<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 cf 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 />Greyling Ins. BrakeragelEPIC
<br />NCONAMTACT Katie Kresner
<br />I:
<br />PICNN FA ; 770.552.4225 I FAX
<br />NCI: 866.550,4082
<br />3780 Mansell Road, Suite 370
<br />Alpharetta, GA 30022
<br />-
<br />E-MAIL ae.resner re Iln
<br />ADDRESS: Ktii{ @g y g• com
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIL of
<br />INSURER A: Nautilus Insurance Company
<br />17374
<br />INSURED
<br />INSURER B. Great Divide Insurance Company
<br />25224
<br />Group, Inc.
<br />M
<br />INSURER C; Ohio Security Insurance Company
<br />24082
<br />4000
<br />400a Miller C�t,rt west
<br />ller Court
<br />_
<br />$100 000
<br />Norcross, GA 30071
<br />INSURER D.
<br />_..___
<br />INSURER E:
<br />INSURER F:
<br />COVERACaES CERTIFICATE NLINIBER7 11 -IM RF-vl inm NIIMRFR!
<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, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />IN R ADDL SORR - -- - - -- - -- POLICY EFF POLICY EXP - -- -.. ....-- --
<br />TYPE OF INSURANCE NS O POLICY NUMBER MMIODIYYYY MMIDDIY'YYY LIMITS
<br />A
<br />X
<br />_
<br />COMMERCIAL GENERAL LIABILITY
<br />ECP201603712
<br />1010812017
<br />1010812D1
<br />EACH OCCURRENCE
<br />$1000000
<br />CLAIMS -MADE F OCCUR
<br />F�REM SE9 EaEoNcaTinence
<br />_
<br />$100 000
<br />MFD EXP (Any one pereon)
<br />5 5a 00
<br />_
<br />PERSONAL & ADV INJURY
<br />$1,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY � JECTT LOC
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />GEN'L
<br />PRODUCTS - COMPIOP AGG
<br />- ._T_..'Y
<br />$2,000,000
<br />$
<br />OTHER:
<br />C
<br />AUTOMOBILE
<br />LIABILITY
<br />BAS1858312554
<br />010812817
<br />110/08120111,
<br />COMBINED SINGLE Ukll7
<br />Ea BIKED
<br />1,000,000
<br />BODILY INJURY (Per person)
<br />S
<br />ANYAUTO
<br />••
<br />•
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />HIRED AUTOS X NON - OWNED
<br />AUTOS
<br />BODILY INJURY (Per acddenQ
<br />S
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />EACHOCCURRENCE
<br />UMBRELLA LIAR OCCUR
<br />FFX201603812
<br />A
<br />0108/2017
<br />1010812018
<br />$5000000
<br />GR_EGATE
<br />s5,000,00
<br />X1
<br />EXCESS LIAR X CLAIMS -MADE
<br />DED I X1 RET£NTIONSO
<br />_AG_
<br />S
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNERIEXECUTIVC Y I N
<br />OFFICERRJEMBER EXCLUDED? �
<br />NIA
<br />WCA201603612
<br />10108/2017
<br />101081201.9
<br />7t PER OTH
<br />- - - -- ER
<br />E.L EACH ACCIDENT
<br />$1,000,000
<br />$1,000,000
<br />(Mandatory in NN)
<br />E.L. DISEASE - EA EMPLOYEE
<br />If yes, descrlba under
<br />DESCRIPTION OF OPERATIONS below
<br />' - - - - - -- -- - - -- - -- -
<br />E.L. DISEASE - POLICY LIMIT
<br />$1,080,000
<br />A
<br />Professional Liab
<br />_
<br />ECP201603712
<br />1010812017
<br />_
<br />10108/201
<br />Per ClaimlAgg $1 MI$2M
<br />Contractors Poll.
<br />ECP201603712
<br />1010812017
<br />1010812018
<br />PerCondition $1,000,000
<br />Liability
<br />A re ate $2,000,000
<br />DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES (ACORD 1111, AddItIonat Remarks Schedule, may be attached If more space Is requivad)
<br />Excess Liability includes Professional Liability, 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 />LeS�ii11�L9� ■T�Ii L�J�Uaf Df111: LRI ml 01 ■_A I Le1C
<br />Orange County
<br />PO Box 8181
<br />Hillsborough, NC 27278
<br />ACORD 25 (2014101) 1 of 1
<br />#S8720181A11871590
<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 />A211V
<br />071988 -2014 ACORD CORPORATION, All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />KKRE1
<br />
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