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DocuSign Envelope ID:7298C647-357F-4210-9C30-5CBOE645E4A1 <br /> DATE(MM/DDIYYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE <br /> 1/7/2019 <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 rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT Charter Risk Management <br /> NAME: g <br /> Marsh USA, INC. PHONE FAX <br /> 701 Market Street, Suite 1100 A/C No Ext: (A/C, <br /> A/C No: <br /> St. Louis, MO 63101 E-MAIL certificaterequests@charter.com <br /> ADDRESS: <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> COMPANY A: National Union Fire Ins Co Pittsburgh PA 19445 <br /> INSURED COMPANY B: New Hampshire Insurance Company 23 84 1 <br /> Charter Communications, Inc. COMPANY C: Commerce and Industry Insurance Company 19410 <br /> 400 Atlantic Street <br /> Stamford, CT 06901 COMPANY D: Ace Property & Casualty Insurance Company 20699 <br /> COMPANY E: AIU Insurance Company 19399 <br /> COMPANY F: American Home Assurance Company 19380 <br /> COVERAGES CERTIFICATE NUMBER: 302775 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 SUBR POLICY EFF POLICY EXP LIMITS <br /> LTR IN SD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY <br /> C X COMMERCIAL GENERAL LIABILITY GL 3629906 1/1/2019 1/1/2020 EACH OCCURRENCE $ $1,000,000 <br /> A AGE CLAIMS-MADE � OCCUR PREM SESOEa occurrENTEDence $ $500,000 <br /> MED EXP(Any one person) $ $10,000 <br /> PERSONAL&ADV INJURY $ $1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ $3,000,000 <br /> POLICY PRO ❑ LOC PRODUCTS-COMP/OPAGG $ $1,000,000 <br /> X JECT <br /> OTHER: $ <br /> A AUTOMOBILE LIABILITY CA 1921838 (AOS) 1/1/2019 l/l/2020 COMBINED SINGLE LIMIT $ $1,000,000 <br /> A X CA 1921839 (MA) 1/1/2019 1/1/2020 Ea accident <br /> p ANY AUTO CA 1921840 (VA) 1/1/2019 1/1/2020 BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> D X UMBRELLALIAB X G28119616 004 1/1/2019 1/1/2020 EACH OCCURRENCE $ 1,000,000 <br /> OCCUR <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION See second page for 1/1/2019 l/l/2020 X PER OTH- <br /> AND EMPLOYERS'LIABILITY Y/N specific policy 1/1/2019 1/1/2020 STATUTE ER <br /> ANYPROPRIETOR/PARTNER/EXECUTIVE N information. 1/1/2019 1/1/2020 E.L.EACH ACCIDENT $ $5,000,000 <br /> OFFICER/MEMBEREXCLUDED? NIA` 1/1/2019 l/l/2020 <br /> (Mandatory in NH) 1/1/2019 l/l/2020 E.L.DISEASE-EA EMPLOYEE $ $5,000,000 <br /> If yes,describe under 1/1/2019 1/1/2020 $5,000,000 <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> E Excess WC OH ($5M Retention) XWC 45955666 (QSI OH) 1/1/2019 l/l/2020 Employers Liability $5,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Please see page 2 for additional insureds and any additional language. <br /> CERTIFICATE HOLDER CANCELLATION <br /> Orange County NC <br /> 131 W Margaret Lane SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> PO BOX 8181 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Hillsborough, NC 27278 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> Joseph M. Lee <br /> ©1988-2016 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />