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DocuSign Envelope ID: F23214B8-OE00-4B20-8C6A-OEB9A497A1DC <br /> ACQ®* CERTIFICATE OF LIABILITY INSURANCE DATE <br /> JMW DI YYYI <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 PRODUCEfi,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the polloy(los)must he endorsed. 11 SUBROGATION IS WAIVED,subject 10 <br /> the terms and conditions of the policy,certain polloles may require an endorsement. A statement on this certificate does not confer rights to the <br /> Certificate holder In lieu of such endOTSement(s). <br /> PRODUCER (704)542-5461 NAM NilEAC7 �1 L KlllttZ Jr <br /> Carmel Commons Insurance Agency P"aNE 704 542-54B1 Ext. FAAc Nu: 704 544-0364 <br /> EMAIL <br /> 6404 Carpel Rd, Suite 204 ADDRESS: <br /> Charlotte, NO 28226 INSURERS AFFORDING COVERAGE NAEC if <br /> INSURER A:AUTO OWNERS INSURANCE COMPANY 18988 <br /> INSURED APPLIED DRIVES 140 INSURER B <br /> 11016 TARA OAKS DRIVE sNSURERC.: <br /> CHARLOTTE, NC 28227 INSURER D <br /> (704)573-2324 Ext. NrURERE; <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 MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS 5U13JECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, <br /> INSR APOL SUOR POLICY EFF POLICY E-1P <br /> LTR TYPE OF INSURANCEIRka POLICY NUMBER AWDD1YYYY MMla DNYYV LIMITS <br /> OENERA4 LiAfiiLnY L•ACH OCCURRENCE E 1.000 000 <br /> X COMMEFICIAL GENERAL LIABILITY PREMISES E¢ 300,ODO <br /> CLAIMS-MADE FU OCCUR HIED EXA(Any ono pornup..) 5 10,000 <br /> A Y 014615-35025925-18 08/01/16 06/01/19 PERSONAL aADVINJURY ; 1 OOD 000 <br /> GEN E RA L AGO REGAT E $ 2,000 000 <br /> 0E- E.AGOREGATE LIMITAPPGES PER Pn000CTS•COMP/OP AGG E 21000,000 <br /> PQLICY F7 PRO• LOG $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 4 <br /> p CCId. 1,000,000 <br /> ANY AUTO 0 01D ILY I NJ URY(Po'porwn) $ <br /> Ix <br /> ALL Os NED SCT�ULED BODILYINJURY(Bar ei"KW ll S <br /> AAOH•S P Y 52�-054-996-00 11/16/18 11/16/19PROPERTY DAMAGE <br /> HI RED AUTOS X AUrOS Pe+occldsml <br /> ; <br /> X UMBRELLA LIAR OCCUR EACH OCCURnENCE $ 5,000,000 <br /> A EXCESSLIAB HCLAIMS-MADE 42-840-297-00 07/01/18 07/01/19 A[3 RREGATE. S 6,000,000 <br /> DED RETENTIONS 10DDU $ <br /> WORKERS COMPENSATION V,,'C STATU• DTH• <br /> AND EMPLOYERS'LIABILITY YIN <br /> ANY PROPRIETOFVPAMNEA/EXE CUM VE E"1-EACH ACCIDENT S 11000,000 <br /> A OFRcESo E NHR EXCI.VAED? NIA Y 031715 35D14522 08/01/1 S 08/01/19(Manda E"L.DISEASE•EA EMPLOYEE S 1,000,000 <br /> I I yes,dos cr ibe under <br /> DESCRIPTION OF OPERATIONS below E"L.DISEASE•POLICY LIMIT ; 1,000,000 <br /> I <br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS!VEHICLES (All ash AC OR 1a1,Addl Sl onmP Fit mork■ScheCura,If more.Paco Is Fequlred) <br /> CERTIFICATE HOLDER CANCELLATION <br /> ORANGE COUNTY ASSET MANAGEMENT SERVICES <br /> Al I iSon Cooper SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF,NOTIOE WILL BE DELIVERED IN <br /> acooper@orangecountync.gov ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED R RESENTATIVE <br /> 988-2010 ACORO CORP9+t0TI10N. All rights reserved, <br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD <br />