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DocuSign Envelope ID: F521C9FC-AF1E-46C1-BD79-B6069BD1C2DD <br /> ACO CERTIFICATE OF LIABILITY INSURANCE °"02105/05lM201918 <br /> THIS CERTIFICATE 13 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 certificats holder Is an ADDITIONAL INSURED,the pollay(les)must have ADDITIONAL INSURED provisions or be endorsed. <br /> R SUBROGATION IS WAIVED,subject to the terns and conditions of the policy,certain policies may require an endorsement. A statement on <br /> this certificate doss not confer rights to the certificate holder in lieu of such andomement(s). <br /> CONTACT <br /> PRODUCER NAME, <br /> Jake A Parrott Insurance Agency Inc PHONE , (252)523-1041 lee: (252)623-0145 <br /> 2508 N HERRTTAGE STREET ADDRESS: adavis@parrottins.com PO BOX 3547 INSURER(S)AFFORDING COVERAGE NAIL <br /> KINSTON NC 28502 INSURER A: EMPLOYERS MUTUAL CASUALTY CO 21415 <br /> NSIIREO IN,uRm e: ACCIDENT FUND INSURANCE CO OF AMERICA 10166 <br /> TRI SOLUTIONS,INC DBA TILE RESTORATION INSURER C: <br /> P O BOX 100 INSURER D: <br /> HOOKERTON NC ZMM160 INSURER E: <br /> NSURER F <br /> COVERAGES CERTIFICATE NUMBER. 19120 MASTER 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 RESPECTTO 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 /> LTR TYPE OF INSURANCE vivo POLICY NUMBER (MWQWYYYYI 9AKIDWYYYY11 <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,0D0,D00. <br /> DAMAGE 170-REITI= <br /> CMS-MADE ® MI rre <br /> OCCUR PREMISES Eaxance $CLAIMS-MADE <br /> MED FXP(Any one Person) $ 10,D00. <br /> A Y Y 5DB6997 01/01/2019 01/01/2020 PERSONAL&ADV INJURY $ 1,000'000. <br /> GENL AGGREGATE UMITAPPLIESPER: GENERAL AGGREGATE $ 2,W0,00D. <br /> ®PRO-JECT ❑LOC PRODUCTS-COMPIOPAGG $ 2'�'�' <br /> POLICYt <br /> OTHER <br /> AUTOMOBILE LIABILITY �MBIr.SINGLE LIMIT s 1,000,000. <br /> ANY AUTO BODILY INJURY(Per person) S <br /> A OWNED SCHEDULED Y Y 5ES6997 01/01/2019 01/01/2020 BODILY INJURY(Per aaideMll i <br /> AUTOS ONLY AL703 <br /> HIRED NON-OWNED PROPERTY DAMAGE s <br /> AUTOS ONLY AUTOS ONLY Per eorJdarrt <br /> s <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2,000,00D, <br /> A EXCESS LIAB CLAIMS-MADE 5JB6997 01/0112019 0110112020 AGGREGATE $ 2,000,000, <br /> DED I I RETENTION$ 11 <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LJABILlTY YIN STATUTE ER <br /> ANY PROPRIErORIPARTNIMEXECUTDE04 N NIA Y WCV6152738 11107l2018 11l0712019 <br /> E E.L.EACH ACCIDENT $ 1,000,000 <br /> B OFFICERIMEMBER EXCLU <br /> (Yamw"yInNH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1'000,D00 <br /> CatastrophelJobsits Limit $57,000. <br /> INLAND MARINEIINSTALLATION <br /> A FLOATER 5C86997 01/01/2019 01/01/2020 Deductible 500. <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,AddNlmml Remarks Schedule,may be nmwtwd N mwe apace Is required) <br /> ORANGE COUNTY IS LISTED AS AN ADDITIONAL INSURED AS PERTAINS TO GENERAL LIABILITY,ON A PRIMARY&NON-CONTRIBUTORY <br /> BASIS,INCLUDING PRODUCTS&COMPLETED OPERATIONS,VIAA WRITTEN CONTRACT IN PLACE WITH THIS REQUIREMENT INCLUDED. <br /> ORANGE COUNTY IS LISTED AS AN ADDITIONAL INSURED AS PERTAINS TO AUTO LIABILITY,VWA WRITTEN CONTRACT IN PLACE WITH THIS <br /> REQUIREMENT INCLUDED.WAIVER OF SUBROGATION IN FAVOR OF ADDITIONAL INSURED APPLIES TO GENERAL AND AUTO LIABILITY AND <br /> WORKER'S COMPENSATION,VIAA WRITTEN CONTRACT IN PLACE WITH THIS REQUIREMENT INCLUDED. EXCLUDED OFFICERS IN WORKER'S <br /> COMPENSATION COVERAGE:DAVID ALBRITTON&CHARLES ALBRITTON III. <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 /> PO BOX 8181 <br /> AUTHORED REPRESENTATIVE <br /> HILLSBOROUGH INC 27278 ajsq k {lid <br /> Q 19SB-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD <br />