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DocuSign Envelope ID: FE562994- 247A- 4BEF- A63A- 074755E44AEB
<br />Q0
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MMfQDlYYYY)
<br />6/2512018
<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 pollcy(les) 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
<br />BB &T Insurance Services, Inc.
<br />2108 W. Laburnum Ave Suite 300
<br />PO Box 17370
<br />NAMEACT Tiffany Davenport
<br />PHONE FA1i
<br />• 804-678 -5027 JC Na.888- 751-3010
<br />E
<br />oaRlEss: tdaven ort bbandt,com _
<br />INSURERS AFFORDING COVERAGE
<br />NAIC 0
<br />Richmond VA 23227
<br />INSURER A: Valley Fore Insurance Company
<br />20508
<br />71112018
<br />INSURED 35SMEINC
<br />INSURERS: Continental Insurance Company
<br />35289
<br />S &ME Inc.
<br />3201 Spring Forest Rd.
<br />Raleigh, NC 27616
<br />INSURER C; Travelers Property CasuaU Cc of Amer
<br />25674
<br />INSURER D: American Casualty Co of Reading PA
<br />20427
<br />INSURER E : XL Specialty Insurance Company
<br />37885
<br />INSURER F:
<br />$1,D00,o00
<br />COVERAGES CERTIFICATE NUMBER: 1573430642 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 />I�Tq
<br />TYPE OF INSURANCE
<br />ADDLSUBR
<br />POLICYNUMB'ER T
<br />POLICY
<br />MmmofriYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />Y
<br />Y
<br />6042844344
<br />71112018
<br />71112019
<br />EACH OCCURRENCE
<br />$1,000.000
<br />�
<br />CLAIMS -MADE OCCUR
<br />l "
<br />DAMAGE R
<br />PREMISES Ea oc=rrence
<br />$1,D00,o00
<br />ME EXP (Any one person)
<br />$15,000
<br />PERSONAL 8 ADV INJURY
<br />$1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />S2,ODDXO
<br />POLICY 1K jEGT � LOG
<br />PRODUCTS - COMPIOPAGG
<br />$2,0D0,000
<br />$
<br />OTHER:
<br />1
<br />B
<br />AUTOMOBILE LIABILITY
<br />Y
<br />Y
<br />6042844313
<br />71112018
<br />7/112019
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />-$ 1 060.000
<br />BODILY INJURY (Per person)
<br />$
<br />X ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per aocident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />X HIRED X NON - OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />C
<br />X
<br />UMBRELLA LIAB
<br />X
<br />,OCCUR
<br />Y
<br />Y
<br />ZUP51M5239518
<br />7/112018
<br />7/112019
<br />EACH OCCURRENCE
<br />$ 5,o00 Doo
<br />AGGREGATE
<br />$5,000,000
<br />EXCESS LIAB
<br />CLAIMS-MADE
<br />DED I X I RETENTION $ 5
<br />$
<br />❑
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANYPROPRIETORIPARTNERIEXECUTIVE
<br />Y
<br />VVC'.642647965
<br />71112016
<br />7/112019
<br />X STATUTE ERR-
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />OFFICE RIM EMBER ExCLIU DEDI
<br />NIA
<br />L_J
<br />(Mandatory in NH)
<br />E.L DISEASE- EA EMPLOYEE
<br />$1,000,000
<br />E.L. DISEASE - POLICY LIMIT
<br />$1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E
<br />Professional Liability
<br />including Pollution
<br />DPR9927327
<br />71112018
<br />711/2019
<br />5,000,000
<br />5,009,000
<br />Per Claint
<br />Aggregate
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACCRD 1al, Additional Remarks Scheduta, may be attached If more space is required)
<br />Umbrella policy extends over General Liability, Automobile Liability and Employers' Liability coverages.
<br />In the event that the Company cancels the General Liability, Automobile Liability or Employers' Liability policies for any statutorily permitted reason other than
<br />non - payment of premium, the Company agrees to provide ninety (90) days notice of cancellation of the Policy to any entity with Whom the NAMED INSURED
<br />agreed in a written contract or agreement would be provided with notice of cancellation of the policy.
<br />in the event that the Company cancels the Professional Liability policy for any statutorily permitted reason other than non - payment of premium, the Company
<br />agrees to provide thirty (30) days notice of cancellation of the Policy to any entity with Wham the NAMED INSURED agreed in a written contract or agreement
<br />See Attached...
<br />CERTIFICATE HOLDER CANCELLATION
<br />b 1988 -2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016 /03) The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Orange County
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Dept. of Environment, Agriculture, Parks and Recre
<br />ACCORDANCE WITH THE POLICY PROVISIONS,
<br />Attn: Thomas Davis
<br />AU'T'HORIZED REPRESENTATIVE
<br />I
<br />306 A Revere Road
<br />PO Box
<br />ugh
<br />Hillsborough NC 27278
<br />b 1988 -2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016 /03) The ACORD name and logo are registered marks of ACORD
<br />
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