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DocuSign Envelope ID:94F04810-ED21-4E95-8CDC-D0182lE590AE <br /> CERTIFICATE OF LIABILITY INSURANCE °ATEIMMlIADlYYYY, <br /> 11/16/2018 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 CONTACT- Jami McMillian <br /> StateFarm GARY ELLIOTT NAME_PHONE g1 g_g42-6057 FAX <br /> Am <br /> arc Ext Are No: 919-9fi$-1948 <br /> CHAE.FRANKLIN ST.STE 210 ADDRESS: jami @chapelhiilsf.com <br /> CHAPEL HILL,NC 27514 <br /> INSURER S AFFORDING COVERAGE NAIC# <br /> INSURED INSURERA: State Farm Fire and Casualty Company 25143 <br /> KEENAN WILLIAMS INSURER B: <br /> 730 EAGLE POINT RD INSURER C: <br /> PITTSBORO,NC 27312-6176 INSURER D: <br /> INSURER E: <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 ADDLSUBR <br /> LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP <br /> MMRlD1YYYY 5 (MMMpfyVyyl LIMITS <br /> COMMERCIAL GENERAL LIABILITY <br /> EACH OCCURRENCE $ 1,000,000 <br /> CLAIMS-MADE ®OCCUR PRE E E <br /> PREMISES Eaoccurrrence $ <br /> 93-CV-P059 5 <br /> MED EXP(Any one person) $ <br /> 09/11/2018 09/11/2019 PERSONAL&ADV INJURY $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> POLICY PRO <br /> JECT 0 LOC <br /> PRODUCTS-COMPfOPAGG $ <br /> OTHER <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> Ea accident <br /> ANY AUTO <br /> OWNED SCHEDULED BODILY INJURY(Parperson) $ <br /> AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ <br /> HIRED NON-OWNED <br /> AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE $ <br /> Per acciden# <br /> $ <br /> UMBRELLA LMB OCCUR EACH OCCURRENCE $ <br /> EXCESSLIAB CLAIMS-MADE AGGREGATE <br /> DED RETENTION$ <br /> WORKERS COMPENSATION $ <br /> AND EMPLOYERS'LIABILITY YIN S AR EE <br /> ANY PROPMETORIPARTNERIEXECUTIVE EL.EACH ACCIDENT $. <br /> OFFICER/MEMBEREXCLUDED? 0 NIA <br /> (Mandatory In NH) <br /> !f stl under E.L.DS <br /> Ce EASE-EA EMPLOYE $s <br /> DRIPTION <br /> OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES {ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ORANGE COUNTY ACCORDANCE WITH THE POLICY PROVISIONS. <br /> PO BOX 8181 <br /> HILLSBOROUGH,NC 27278 AUTHORIZED RESENTATIVE <br /> 1988-2016 ACORD CORPORATION. All rights reserved. <br /> ACORD 26(2016103) The ACORD name and logo are registered marks of ACORD <br /> 1001486 132849.12 03-16-2016 <br />