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DocuSign Envelope ID:7DO44905-CC77-4EOC-84C3-675B48A32380 <br /> CERTIFICATE OF LIABILITY INSURANCE nA 111n6 11F;1zo1a1'-nlR"' <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 RY 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 POIICy0es)must have ADDITIONAL INSURED provisions or he endorsed. <br /> If SUBROGATION IS WAIVED,subject to the terms and conditions of the Po11cy,certain Policies may require an endorsement. A statement on <br /> this sartificate does not confer rig hts to the certificate holder In lieu of such endorsements. <br /> PRODUCER �NIAOMN Er Jami McMillian <br /> S: <br /> jr7LT€� e�111 GARY ELLIOTT NE 919-942-605T FAx919 968-194t3ca 1805E.FRANKLIN ST.STE210 <br /> IL aml CRess: j hapelhillsl.cvm <br /> CHAPEL HILL,NC 27514 - <br /> INSUR6R 8 AFFORDING COVERAGE NAIC$ <br /> INSURED <br /> INSURER A:State Farm Fire and Casualty Company 26143 <br /> INSURER S; <br /> tCEENAN WIELIAMS <br /> 730 EAGLE POINT RD INSURER C <br /> ; <br /> PiTTSBORC3,NC 27312 5176 INSURER D <br /> INSURER E- <br /> INSURER P; -- <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 PAIL)CLAIMS. <br /> ILTR NSR TYPEDF3NSI}RANC7= AODL BR POLICY POLICYEXP <br /> POLICY NUMBER D MMIflD "RE <br /> LIMITS <br /> COMMFRCIA L GENERAL LIAIRUIV <br /> CE S 1.000.000 <br /> CLAlMS•MApE ®OCCUR Ea D S -- <br /> e a, S <br /> 93 CV-PQ59-5 0911112ff 18 091i 112019 INJURY S <br /> G£N'L AGGREGATE UA11T APPLIES PER: GATE 5 2,OOO,000 <br /> POLICY jEC7 LOC <br /> PRODUCTS-COMPIOPAGG $ <br /> OTHER! <br /> 5 <br /> AUTOMOBILE LIABILITY COME3l�7EnDISINGLE UN IT S <br /> MEDrO O 9CDILY INJURY(Parperson) E - <br /> 4hNED SCHEDULED _ <br /> AUTOS ONLY AUTOS <br /> HIRED NON•CWvNED BODILY INJURY(Per accident) S <br /> PROP@RTY DAMAGE AUTOS ONLY AUTOS ONLY a� S <br /> S <br /> UMBRELLA L1A5 OCCUR EACH OCCURRENCE <br /> f <br /> EXCESS LIAR CLAIMS-MADEAGGREGATE <br /> S <br /> DED RETENTION <br /> WORKERS COMPENSATION <br /> AND EMPLOYERV UASIL" Yl N PTR UTE ERH <br /> ANY PROPRIETOWPARTNERiEXECUTIYE ❑O E.L.EACH Accltli:wT $ <br /> FFICERrMEMBER EXCLUDE NIA A O7 <br /> Ues,deSr�Ibe under alaly In Nil) E.L.DISEASE-EA EMPLOYE $ <br /> 1f yyes, <br /> DESCRIPTION OF OPERATIONS 6ol7N E.L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEFHC LES(ACORD 101,Additional Remarks schedule,may be anached R mare ePa CO Is re quEred) <br /> I <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ASOVE DESCR1BED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL 13E DELWERED IN <br /> ORANGE COUNTY ACCORDANCE WITH THE POLICY PROVISIONS. <br /> PO Sox 8161 <br /> HILLSBOROUGH,NC 27278 AUTHORIZER E <br /> TATIve <br /> vi— �.0 <br /> 8-z015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD <br /> 1001485 132849.12 03-16-ZIA <br />