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DocuSign Envelope ID: 07544334- 5B9F- 40DO- 82E8- EO5770411 D3C
<br />MYSTE -1 OP ID: ML
<br />,a►coRO° CERTIFICATE OF LIABILITY INSURANCE
<br />DA08 /23 /2018Y)
<br />08/23/2018
<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 of 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 />Insurance People
<br />P. O. Box 3006
<br />CONTACT
<br />PHONE FAX
<br />AIC No Ext : AIC, No),
<br />E -MAIL
<br />ADDRESS:
<br />Durham, NC 27715 -3006
<br />Michelle R. Long
<br />COMMERCIAL GENERAL LIABILITY
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A: Cincinnati Ins. Co.
<br />10677
<br />$ 1,000,000
<br />INSURED Mystery Brewing Co., LLC
<br />INSURER B: Employers Preferred Ins. Co.
<br />X
<br />437 Dimmocks Mill Rd., Ste 41
<br />Hillsborough, INC 27278
<br />INSURER C,
<br />04/01/2018
<br />04/01/2019
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />INSURER D :
<br />INSURER E:
<br />$ 10,000
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<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 />DDL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDIYYYY
<br />POLICY EXP
<br />MMIDD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE 1XI OCCUR
<br />X
<br />ETD 0380273
<br />04/01/2018
<br />04/01/2019
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$ SOO,000
<br />MED EXP (Any one person)
<br />$ 10,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY ❑ PRO-
<br />POLICY [::] LOC
<br />PRODUCTS - COMP /OP AGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />I
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000 000
<br />> >
<br />BODILY INJURY (Per person)
<br />$
<br />A
<br />ANY AUTO
<br />ETD 0380273
<br />04/01/2018
<br />04/01/2019
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />X
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />X NON -OWNED
<br />HIRED AUTOS AUTOS
<br />X
<br />UMBRELLA LAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />AGGREGATE
<br />$ 1,000,000
<br />A
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />ETD 0380273
<br />04/01/2018
<br />04/01/2019
<br />DED RETENTION $
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR /PARTNER/EXECUTIVE YIN
<br />EIG2591823
<br />01/12/2018
<br />01/12/2019
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />OFFICER /MEMBER EXCLUDED? ❑
<br />(Mandatory in NH)
<br />N / A
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />A
<br />Liquor Liability
<br />ETD 0380273
<br />04/01/2018
<br />04/01/2019
<br />OCC. 1,000,000
<br />Agg. 2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Event: LocalFest 09/29/19
<br />Orange County Government is additional insured with regards to General
<br />Liability per written contract as their interest may appear.
<br />CERTIFICATE HOLDER CANCELLATION
<br />Orange County Government
<br />P.O. Box 8181
<br />Hillsborough, INC 27278
<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 />Michelle R. Long
<br />©1988 -2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />
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