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DIXON -2 OP ID_ CM
<br />)ocubign Envelope ID: BD95A745- 4862- 4B77- B1G2- F37E827F18AB
<br />"4� CERTIFICATE OF LIABILITY INSURANCE
<br />DATE 08 07/201 YY)
<br />asra7r2o1s
<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 />PRODUCER 828- 648 -2632
<br />Patton, Morgan & Clark
<br />P O Box 1027
<br />CONTACT Patton, Morgan 8� Clark
<br />NAME:
<br />(A/CC, N , Ext :828- 648 -2632 FAX, Npi:828- 646 -2542
<br />Canton, NC 28716
<br />Patton, Morgan & Clark
<br />EMAIL
<br />ADD E
<br />630- 5E183024- COF -18
<br />06/01/2018
<br />06/01/2019
<br />INSURERS AFFORDING COVERAGE
<br />NAIC N
<br />INSURER A:The Travelers Companies Inc,
<br />25682
<br />INSURED Dixon Hughes Goodman LLP
<br />P.O. Box 3049
<br />INSURER B:
<br />PERSONAL & ADV INJURY
<br />Asheville, NC 28802
<br />INSURER C:
<br />GENERAL AGGREGATE
<br />INSURER D
<br />PRODUCTS - COMP)OPAGG
<br />2,000,000
<br />INSURER E:
<br />A
<br />INSURER F :
<br />LIABILITY
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS p
<br />HIRED ONLY X AUOTND ONLY
<br />COVERAGES CERTIFICATE NIfMRFR• RFVICInK1 NI IMRFw•
<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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXP
<br />LIMBS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />630- 5E183024- COF -18
<br />06/01/2018
<br />06/01/2019
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO RENTED n
<br />$ 1,000,000
<br />MED EXP (Any one erscn
<br />10,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />X POLICY ❑ LECT F-1 LOG
<br />pTHFft
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />PRODUCTS - COMP)OPAGG
<br />2,000,000
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS p
<br />HIRED ONLY X AUOTND ONLY
<br />BA- 5E261842- 18 -CAG
<br />06/01/2018
<br />06/01/2019
<br />COMBINED SINGLE LIMIT
<br />$ 1,000,000
<br />SODIt_Y INJURY Per person)
<br />SOD ILYINJURY Per accident
<br />I X
<br />PROPERTY d IDAMAGE
<br />$
<br />A
<br />X
<br />UMBRELLA LIAB
<br />EXCESS LOLB I
<br />X
<br />OCCUR
<br />I CLAIMS -MADE
<br />I
<br />CUP- IJ921907 -18-43
<br />06/01/2018
<br />06/01/2019
<br />EACH OCCURRENCE
<br />15,000,000
<br />AGGREGATE
<br />15,000,000
<br />DED I X RETENTION $ 10000
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y J N
<br />ANY PROPRIETDRIPARTNERJEXFCUTIVF ❑
<br />FMand WME NH] EXCLUDED? N
<br />If yes, describe under
<br />DESCRIPTION" OPERATIONS below
<br />NIA
<br />UB- 6K186824- 18 -43 -G
<br />06/01/2018
<br />06/01/2019
<br />X PER QTH-
<br />STATUTE ER
<br />E L EACH ACCIDENT
<br />1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />1,000,000
<br />$
<br />E.L. DISEASE - POLICY LIMIT
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS J VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />ORANGC5
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Orange County Health Dept. ACCORDANCE WITH THE POLICY PROVISIONS.
<br />300 W Tryon St.
<br />Hillsborough, NC 27278
<br />AUTHORIZED REPRESENT IVE �
<br />Patton, Morgan & la
<br />ACORD 25 (2016103) ©19q8-201 6 ACOj2D CORPORATION. All rig- reserved.
<br />The ACORD name and logo are registered marks o ACORD
<br />
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