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DocuSign Envelope ID: 2DE05616- 854F- 452D- B3E4- 46548CF7A662 <br />� DATE{ � �- OD1YYi'y <br />ASR° CERTIFICATE OF LIABILITY INSURANCE 0E(WhDD018 <br />Insurance Plus 800 -515 -8822 <br />Willis of New York, Inc., Brookfield Place <br />200 Liberty Street, 6th Floor <br />New York, NY 10281 <br />INSURED <br />Elijah Pruitt <br />3703 Borland Rd <br />Efland, NC 27243 <br />COVERAGES <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />E INSURERS AFFORDING COVERAGE NAG <br />INSURER n Aspen Specialty Insurance Company ,1_0_.717 <br />__ .Repgrt_all_claims_to_Insurance P.lus_Program_via_e mail.at <br />ProfessionalL iabilityClaims@a aspen- insurance ,cam <br />_ _..... _...... - - - - -- - -- <br />Ins. # 177133 INSURER 0; .- ..._.. <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTAN DING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH <br />THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS ANO CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INS§ ADO'l. _.....___ ...... ............. ....._.. _......... _..... _.... - -..., - POLICY EFFECTIVE - AL <br />E OF INSURANCE POUCYNUMSER <br />.... ....._L.I.. M ITS ........ _ .....___ ...... <br />:GENERAL LIABILITY � <br />EACH OCCURRENCE S2,OOD.000 <br />.. <br />X COMMERCIAL GENERAL LIABILITY - 07105J2018 - 07T05f2O19 : <br />--DAMAGE TO RENTED ... ...... _...._...._. ......... <br />PREMISES .(ED occurrence} : 510D,000 <br />' OCCUR <br />CLAIMS MAD> '+t #LRAFVTX17A0M ; <br />MED EXP (Anyone parson) ) is WA <br />A <br />PERSONAL & ADV INJURY $ 2.000.000 <br />.. _... ........... ........... .. .. <br />GENERAL AGGREGATE ! $ 3,01KI 000 <br />...... ......._ . ... .. _._ .. ....._..._.. .._..._. . ......_.._.. <br />GEN'L AGGREGATE LIMIT APPLIES PER; <br />PRODUCTS - COMPIOP AGG 5 2,000,000 <br />I'Rb- POLICY LOG <br />; . <br />BUS. PERS, PROP, AGG I DED ! $1,0001 $260 <br />AUTOMOBILE LIABILITY <br />- <br />COMBINED SINGLE LIMIT $ <br />ANY AUTO <br />(Ea accident) <br />ALL OWNED AUTOS <br />BODILY INJURY <br />SCHEDULED AUTOS <br />(Per person) $ <br />. HIREDAUTOS <br />BODILY INJURY r <br />NON -OWNED AUTOS <br />(Per aceworit) <br />............ ......_ .. ..............__. <br />PROPERTY DAMAGE <br />- <br />(Par suMontt <br />GARAGE LIABILITY <br />AUTO ONLY -EA ACC #DENT S <br />ANY AUTO <br />OTHER THAN EA ACC..!. S _--- _ ............... - - - -- -- <br />AUTO ONLY: AGG $ <br />EXCESS 1 UMBRELLA LIABILITY <br />EACH OCCURRENCE S <br />OCCUR CLAIMS MADE <br />AGGREGATE is <br />I <br />�S <br />DEDUCTIBLE I <br />F � <br />S <br />RETENTION S <br />$ <br />WORKERS COMPENSATION <br />'YVC STATU i OTH -' <br />TORY LIMITS' <br />AND EMPLOVERV LIABILITY ._. <br />Y1 <br />_.. ...... :_.ER —_.. ._..._.. .._.... <br />ANY PROPRIETORIPARTNERIEXECUTIV£ <br />F1. EACH ACCIDENT <br />OrACERIM14MOER EXCLUDED? <br />" <br />-• (Mandatory In NH) - <br />E.L. DISEASE • EA EMPLOYES. $ <br />Pus <br />S EC duaribe 0 <br />E. L. DISEASE - POLICY LIMIT 1 $ <br />OTHER <br />A Professional Liability #LRAFVTXI7A0M <br />2,000,OOD per aecurrenur 153.000.000 PA0001 <br />07/05/2018 07/05/2019 <br />aggravate <br />DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES I EXCLUSIONS ADDEDBY ENDORSEMENT 1 SPECIAL PROVISIONS <br />Not Applicable <br />;jrK I It- It ,^ I G rIULiJCM LH M,r -LLH I iUry <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN <br />Not Applicable NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />REPRESENTATIVES, I <br />AUTHORIZED REPRESENTATIVE <br />ACORD 25 (2009101) U 1988 -2000 ACORD CORPORATION. All rights reserved. <br />INS026(20090t) The ACORD name and logo are registered marks of ACORD <br />