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DocuSign Envelope ID:3E240EC7-E4F0-4989-8D50-D6C95F8F9E28 GATE{MMIDDIYYYYI � CERTIFICATE OF LIABILITY INSURANCE 10/4/2018 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(les)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 endersement(s). PRODUCER CONTACT NAME: Lynne Meyer,CIC,CPIW,A_INS Marsh&McLennan Agency LLC pHOHa E .336-346-1302 FiaAX Not:336-34fi-1397 f,VC 3625 North Elm St E-MAIL Greensboro NC 27455 ADDRESS: Lynne.Meyer@u marshmma,com INSURER(S)AFFORDING COVERAGE _ NAIC# INSURER A:Builders Premier Insurance Corn pa n y 13036 INSURED BIRSI-2 INSURERS:Columbia Casualty Company 31127 SIRS, Inc. Mr.Raven Broeker INSURER C:Builders Mutual Insurance Company 10844-_ PO Box 36197 INSURER D Greensboro NG 27416-6197 INSURER E: -- INSURER r: COVERAGES CERTIFICATE NUMBER:1625434416 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN 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. ILTR TYPE OF INSURANCE ADUL SUER ------ --ODOM-Y Er-F POLICY EX INSD WVD POLICYNUM13ER 1MMfDDfyYYY1 IMMIDDIYYYY) LIMITS _ A X COMMERCIALGENERALLIABILITY PCPDO03632 51V20-i8 512019 EACH OCCURRENCE $1,000,000 CLAIMS-MADE ®OCCUR D MIGETO TE❑ PRESES(Ea oocurrencal _ _$_100,000 MED EXP Any One Germ) $5,600 PERSONAL&ADV INJURY $1,000,000 GEN1-AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,1100,000 POLICY u jE� P RO_DU_CTS-COMP/OP AGG $2.000,000 OTHER: u LOG f $ A AUTOMOBILE LIABILITY PCA0018423 51112018 511r2019 COMBINEDSINGLELIMIT $1,ODO.Wo iEa rcldenl ANY AUTO BODILY INJURY(Par parson) S OWNED SCHEDULED AUTOS ONLY AUTOS 6GplLY INJURY(Per arclden!) $ x HIRED X NON-OWNED PRaPE RTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per aceldent I Com oil Ded $1,000f1,000 C X UMBRELLALIAB X OCCUR MU130001286 SIV2018 51112019 EACH OCC ORR ENCE $5,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE 3 5,000,000 OED I X RETENTIONS S E A WORKERS COMPENSATION PWC100020008 51"12018 51"1"12019 X PER AND EMPLOYERS'LIABILITY YIN STATUTE ER _ ANYPROPRIETMPARTNERIEXECUTIVE F--1 E.L.EACH ACCIDENT S 1,000.00D OFFICERWEMBER EXCLUDED? NIA —--- - --- {Mandatary in NHI E.L.DISEAASE-EA EMPLOYEE $1,000,00D If yes,describe under DESCRIPTION OF OPERATIONS hetow E.L.DISEASE-POLICY LIMIT $1,DDO,00fl A Rental E ulpment ` PCPODDM32 5IU2018 5!12019 160,000 B E&OIPa�lullaa CE0501855096 5/112016 U1C2D19 1,00D,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 1O"1,AddRIGnal Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Orange County PO Box 85181 At1,TORIZED REPRESENTATIVE, iiiilsharDUgh NC 2727'8 ]J'1 C7 1988.2015 ACORD CORPORATION, All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD