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DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE <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 />CONTACTPRODUCERNAME: <br />FAXPHONE(A/C, No):(A/C, No, Ext): <br />E-MAILADDRESS: <br />INSURER(S) AFFORDING COVERAGENAIC # <br />INSURER A : <br />INSURED INSURER B : <br />INSURER C : <br />INSURER D : <br />INSURER E : <br />INSURER F : <br />COVERAGESCERTIFICATE 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 />ADDLSUBRINSR POLICY EFFPOLICY EXPTYPE OF INSURANCE LIMITSPOLICY NUMBERLTR (MM/DD/YYYY)(MM/DD/YYYY)INSDWVD <br />COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE$ <br />DAMAGE TO RENTEDCLAIMS-MADEOCCUR $PREMISES (Ea occurrence) <br />MED EXP (Any one person)$ <br />PERSONAL & ADV INJURY$ <br />GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ <br />PRO-POLICYLOC PRODUCTS - COMP/OP AGG$JECT <br />$OTHER: <br />COMBINED SINGLE LIMITAUTOMOBILE LIABILITY $(Ea accident) <br />BODILY INJURY (Per person)$ANY AUTO <br />ALL OWNEDSCHEDULED BODILY INJURY (Per accident)$AUTOSAUTOSNON-OWNED PROPERTY DAMAGE $HIRED AUTOS (Per accident)AUTOS <br />$ <br />UMBRELLA LIAB EACH OCCURRENCE$OCCUR <br />EXCESS LIAB CLAIMS-MADE AGGREGATE$ <br />$DEDRETENTION$ <br />PEROTH-WORKERS COMPENSATION STATUTEERAND EMPLOYERS' LIABILITY Y / NANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT$N / AOFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH)E.L. DISEASE - EA EMPLOYEE$ <br />If yes, describe under E.L. DISEASE - POLICY LIMIT$DESCRIPTION OF OPERATIONS below <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />CERTIFICATE HOLDERCANCELLATION <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 />© 1988-2014 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORDACORD 25 (2014/01) <br />DRAPADE-01JWESTERDALE <br />12/12/2014 <br />Ames & Gough8300 Greensboro Drive <br />Suite 980McLean, VA 22102 <br />(703) 827-2277(703) 827-2279 <br />Continental Casualty Company (CNA) A(XV)20443 <br />Draper Aden Associates, Inc. <br />2206 South Main Street <br />Blacksburg, VA 24060 <br />A Professional Liab.AEH28835114905/14/201405/14/2015 Per Claim/Aggregate5,000,000 <br />A DeductibleAEH28835114905/14/201405/14/2015 Limit125,000 <br />Orange County North Carolina <br />1207 Eubanks Road <br />P. O. Box 17177 <br />Chapel Hill, NC 27516 <br />DocuSign Envelope ID: 5390EF36-4AA1-4377-8652-50D30B3AF28E