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DocuSign Envelope ID:4760801F-0360-474B-B0D7-0BD376DD80EC GILFST1 OP ID: PT <br /> —1 <br /> ACQRO DATE(MMIDD/YYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE 08/12/2016 <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 /> PRODUCER CONTACT <br /> The Insurance Center of Durham NAME: Philip S.Wolf <br /> 1920 Front St.,Suite 710 AICON o Ext:919-471-2541 A No): 919-471-2132 <br /> P.O.Box 15369 E-MAIL Durham,NC 27704- ADDRESS:Phil@insurancecenterofdurham.com <br /> Philip S.Wolf INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A:Auto-Owners Insurance Co. 18988 <br /> INSURED Statler W. Gilfillen & INSURERB: <br /> Valerija Gilfillen <br /> 3302 Saint Marys Rd. INSURERC: <br /> Hillsborough, NC 27278-9726 INSURERD: <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 TYPE OF INSURANCE DDL SUBR POLICY EFF POLICY EXP LIMITS <br /> LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY <br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 <br /> DAMAGE CLAIMS-MADE � OCCUR X 35447799 08/11/2016 08/11/2017 RENT <br /> cu 50,00 <br /> PREMISES Ea occurrence $ <br /> MED EXP(Any one person) $ 5,00 <br /> PERSONAL&ADV INJURY $ Excluded <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 <br /> POLICYFX] PRO- <br /> JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,00 <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> Ea accident <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> NON-OWNED PROPERTY DAMAGE $ <br /> HIRED AUTOS AUTOS Per accident <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DIED RETENTION$ $ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE I I ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? ❑N/A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) <br /> Management Consultant,Architect <br /> CERTIFICATE HOLDER CANCELLATION <br /> ORAN016 <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Orange Count THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> g y ACCORDANCE WITH THE POLICY PROVISIONS. <br /> P O Box 8181 <br /> Hillsborough, NC 27278 <br /> AUTHORIZED REPRESENTATIVE <br /> Philip S.Wolf <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br />