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DocuSign Envelope ID:6A6B17DA-7C81-4C16-AA4F-2855F76ECDD7 <br /> Client#:2133734 84FEARNHIS <br /> DATE I M MIDDIYYYY) <br /> ACORD-., CERTIFICATE OF LIABILITY INSURANCE 1110912018 <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 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 any rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTANAME cr Kristen Livegod <br /> McGriff Insurance Services PItvNE 336 733-0233 FAX <br /> A7C No 888 632-4236 <br /> AIC No Ext• <br /> 250 W. First Street E-MAIL ADDRESS: meood kiiveng @ 9 riffinsurance.com <br /> PO Box 168 INSURERIS AFFORDING COVERAGE NAIL R <br /> Winston-Salem, NC 27102 INSURER A mre Hanrins.me company 22292 <br /> _ <br /> INSURED INSURER8: <br /> Fearnbach History Services, Inc. <br /> INSURER c s <br /> 3334 Nottingham Road <br /> INSURER D <br /> Winston Salem,NC 27104 <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 CONTRACTOR 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 /> " <br /> 'SR ADDLSUBR POLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE I SR WVD POLICY NUMBER MMIDDrYYYY MMIDDIYYYY LIMITS <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S <br /> CLAIMS-MADE 1-1 OCCURPRVMIS$� �El� S <br /> MED EXP(Any one person) $ <br /> PERSONAL&ADV INJURY $ <br /> GEN'LAGGREGATE LIMITAPPUES PER: GENERAL AGGREGATE $ <br /> PRO- PRODUCTS-COMPIOPAGG $ <br /> POLICY❑JEC7 LOC <br /> OTHER: 5 <br /> AUTOMOBILE LIABILITY _ COMBINED SINGLE LIMIT <br /> a accident <br /> ANY AUTO BODILY INJURY(Per person) 3 <br /> OMED SCHEDULED BODILY INJURY(Per accident) S <br /> AUTOS ONLY AUTOS $ <br /> HIRED <br /> ONLY AUTOS ONLY PROPERTY DAMAGE <br /> UMBRELLA LIAR OCCUR EACH OCCURRENCE 5 <br /> EXCESS LIAR HCLAIMS-MADE AGGREGATE 5 <br /> OED I I RETENTIONS 5 <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS"LIABILITY <br /> YIN <br /> ANY PROPRIETORIPARTNERIEXECUTIVE E:L EACH ACCIDENT S <br /> OFFICERIMEMSEA EXCLUDED? N I A <br /> tMandatory in NH) E.L.DISEASE-EA EMPLOYEE 5 <br /> if es,des0be under <br /> DESCRIPTION OF OPERATIONS be[ow E.L.DISEASE-POLICY LIMIT 5 <br /> A Professional LHGD74795900 11/0612018111061201S $1,000,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS i VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> a County Department of SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Orange tY p THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Environmental Agriculture, Parks ACCORDANCE WITH THE POLICY PROVISIONS. <br /> and Recreation <br /> PO Box 8181 AUTHORIZED REPRESENTATIVE <br /> Hillsborough,NC 27278-8181 <br /> C7 1 988-201 5 ACORD CORPORATION.All rights reserved. <br /> ACORD 25(2016103) 1 of'! The ACORD name and logo are registered marks of ACORD <br /> #S219638611M21963859 1 KL <br />