2018-425-E AMS - Sasser Companies Annex upfit

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DocuSign Envelope ID: 9826C043- 4C32- 49CD- A4CC- DC28ABAB7CE7 SASSCOM -01 DBAKER 'ACC]RU CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD YYYY) 02/26/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License #1000009384 CONTACT NAME: PHONE FAX (A/C, No, Et): (336) 228 -0541 (A/C, No):(866) 590 -4281 Hub International Carolinas PO Box 939 Burlington, NC 27216 ADDRIESS: INSURERS AFFORDING COVERAGE NAIC # 02/01/2019 INSURER A: Selective Insurance Company of America 12572 INSURED INSURER B: Accident Fund General Insurance Company 12304 INSURER C : $ 15,000 Sasser Companies Inc INSURER D: PERSONAL & ADV INJURY P O Box 10 Whitsett, NC 27377 INSURER E GENERAL AGGREGATE INSURER F: PRODUCTS - COMP /OP AGG $ 3'000'000 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL IN SD SUBR WVD POLICY NUMBER POLICY EFF MM DD POLICY EXP MM DD LIMBS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F_X] OCCUR S 2253759 02101/2018 02/01/2019 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence 500,000 MED EXP (Any one person) $ 15,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- F—] LOC JECT OTHER: GENERAL AGGREGATE $ 3,000,000 PRODUCTS - COMP /OP AGG $ 3'000'000 • AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY S 2253759 02/01/2018 02/01/2019 COMBINED SINGLE LIMIT Ea accident 1,000,000 $ X BODILY INJURY Per person) $ BODILY INJURY Per accident $ PROPERTY DAMAGE Per accident) $ • X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE S 2253759 02/01/2018 02/0112019 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ D I I RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIMBER/PXCLUDE/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA WCV6139124 02/01/2018 02/01/2019 PER OTH- STATUTE ER E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Orange County is an additional insured under the General Liability for work performed by the named insured for such additional insured, if required by contract signed by an authorized representative of the named insured. CERTIFICATE HOLDER CANCELLATION ACORD 25 (2016/03) © 1988 -2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange Count 9 y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 8181 Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988 -2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD