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'4CCOR°® CERTIFICATE OF LIABILITY INSURANCE D MM/DDIYYYY) <br /> 1//2/2/2014 <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 COT Diana Mausling <br /> Business Insurers of Carolinas PHONE . (919)968-4611 FAX <br /> C Noll:(919)968-8991 <br /> B00 Eastowne Drive, Suite 208 gDDRIESS:dmausling @Business-Insurers.com <br /> PO BOX 2536 INSURERS AFFORDING COVERAGE NAIC# <br /> Chapel Hill NC 27515-2536 INSURERA.Key Risk Management Co-VSWCF 10885 <br /> INSURED INSURERS: <br /> Orange Grove Vol Fire Co. Inc. INSURER C: <br /> 6800 Orange Grove Road INSURER D: <br /> INSURER E <br /> Hillsborough NC 27278 INSURERF: <br /> COVERAGES CERTIFICATE NUMBER:2013-2014 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 ADDL SUER pOUCY NUMBER POLICY EFF IPODICY EXP LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ <br /> COMMERCIAL GENERAL LIABILITY DAMAGE TO EN D <br /> PREMISES Ea occurrence $ <br /> CLAIMS-MADE F-1 OCCUR MED EXP(Any one person) $ <br /> PERSONAL&ADV INJURY- $ <br /> GENERAL AGGREGATE $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ <br /> POLICY PRO LOG $ <br /> AUTOMOBILE LIABILITY COMcciBINED SINGLE LIMIT <br /> Ea adent <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Peraccident) $ <br /> AUTOS AUTOS <br /> NON-OWNED PROPERTY DAMAGE $ <br /> HIREDAUTOS AUTOS Paraccdent <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED I I RETENTION $ <br /> A WORKERS COMPENSATION X WC STATU- I OTH- <br /> AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $ 100,000 <br /> OFFICER/MEMBER EXCLUDED? 112770 /1/2013 7/1/2014 <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 100,000 <br /> If yes,descr be under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,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 /> AUTHORIZED REPRESENTATIVE <br /> Steve Floyd/DIANA "` <br /> ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> INS025!7n1nn51 nt Thn Orr1Rr1 namo nnel Innn�ru ranicfnrerl mnrkc of err)Rr1 <br />