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DocuSign Envelope ID:07220EE1-BE39-473D-A9FD-AC98BDF2EBBE <br /> CERTIFICATE OF LIABILITY INSURANCE OATElMMIDWYYYYI <br /> 01/31/2019 <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)r 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 endorsements. <br /> PRODUCER 14 0TT CT Larry D Durham,Sr <br /> Larry D Durham,Sr 83-286_5 546 __ JA•�.Nol: 8Femx 03-2t6--8-9 3--2PHONEIRS,-N0,Ea): <br /> 1733 Airport Rd <br /> E-MAIL <br /> ADDRESS: � <br /> larry.durham.cibo@gtateform.com <br /> Lancaster SC 29720 iN$URER(S}AFFOROING COVERAGE NAIC4_ <br /> __.......__`____—.-__ INSURER A.State Farm Fire and Casualty Company 25143 <br /> INSURED <br /> ---- INBURERB; ..._ _ <br /> Hutchens,Moore and Associates,LLC INSURER C: v <br /> 2043 Hunters Ridge Rd INSURER D:__ - - <br /> f Lancaster SC 29720-7004 INSURER E: <br /> fi INSi1RER f <br /> COVERAGES CERTIFICATE NUMBER: 007 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 15 SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR -..._. AODLI81f9tt <br /> LTR TYPE OFINSURAHCE I POLSCY NUMBER MMlgg7YYYY MMlOOIYYYY LIMITS <br /> COM MERCSq L G ENERAL LIR BILITY <br /> EACH OCCURRENCE $ 1,000,000 <br /> Is�NT£I)- <br /> CLAIMS-MADEM OCCUR P J$F�S I occi�rrerce _S_500,000 ---. <br /> MED EXP(Any ono persvr5} 3 10,000 <br /> J j Business Of ce-MISC 99-BB-M475-9 F 01/05/2019 01/05/2020 PERSONAL&AOV INJURY S 1,000,000 <br /> GEN'LAGGREGATE LIMIT APPLIES PER: GENERALAGGREGAIE S 2,000.000 <br /> POLICY❑ EI LOC PRODUCTS-COAiptopAGG S '2,00O,Q0a <br /> OTHER. Business Property Actual Loss S 10,300 <br /> AUTOMOBILE LIABILITY CONISiNEDSING LRAIT S <br /> ANY AUTO <br /> I BODILY INJURY(Perpef n) 5 <br /> OWNED AUTOS <br /> BODILY INJURY <br /> AUTU5 ONLY AUTOS [Per arxadHrt( S <br /> ri:IPD NON-OWNED PROPFRTY DAh1P.GE S -�f ---- <br /> -.. AUTOS ONLY _ AUTOS ONLY A— nil - <br /> UMBRELLA UAH OCCUR EACH DCCURREN_CE____ 5 <br /> EXCESS LIAR CLAIMS4 ,OE AGGREGATE-- 5 <br /> DED RCrENTION S S <br /> WORKERS COMPENSATION I PER IDll-l- <br /> AND EMPLOYERS'LIABILITY Y r NI STATI.M J CR <br /> ANY PROPMETORIPARTNERfEXECUTIVE F.L.EACH ACCIDENT S <br /> OFFICCRiM_MBER EXCLUDED? ❑ NIA --- _ <br /> (Mandatory In NH) E.L_DISEASE-EA EMPLOYE ES <br /> If yea,desenbo under •--- <br /> UESCRIPTIONOFOPERATIONSbokm E.L DISEASE-POI--rT 5 <br /> DESCRIPTION OF OPERATIONS I LQCATXO NS 1 VEHICLES(ACORU 101,AddMunal Remo fks Schedule,may ba attached Lrmere space Is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIE$BE CAN CELLEO BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Orange County Government ACCORDANCE WITH THE POLICY PROVISIONS, <br /> AUTH RITEDRWRE3ENTATIVE - <br /> 01988-2015 ACDRD CORPORATION. All rights reserved. <br /> ACDRD 25(2016/03) The ACDRD name and logo are registered marks of ACDRD <br /> 1001486 132849-12 03-16-2016 <br /> l <br /> i <br /> I <br />