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DocuSign Envelope ID:AE2871`51-01138-4E78-13810-35248133BBDE2 <br /> A CERTIFICATE OF LIABILITY INSURANCE DATE <br /> 07MI12018 ' <br /> R <br /> THIS CERTIFICATE IS ISSUED AS AMATTER 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 CONTRACT BETWIrEN 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(tes)must have ADDITIONAL INSURED provisions or he endorsed. <br /> If SUBROGATION IS WAIVED,subject to the terns 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 /> PRODUCP_R CONTACT C04INe Neang. <br /> NAG E; <br /> JD Fuh'diko&Co.Insurarce,Inc, PHONE <br /> F,rL; (503)293-8325 FAX <br /> Nn; (503J293-5416 <br /> 5727 SW Macadam Ave E-MAIL cnaang@jdluhi€ter.com <br /> ADDRESS; <br /> PO BOX 69506 INSURER(S)AFFORDING COVERAGE NAIL 4 <br /> Pordand OR 97239 arasORERA: National Fire Insurance of Hartford 04 278 <br /> INSURED INSURERS: Continental insurance - 35269 <br /> FXcellanoe IRC INSURE{I C: <br /> 453 Lanier Rd IIasURERD; <br /> INSURER E: _ <br /> Madison AL 35758 aNSURESF: <br /> COVERAGES CERTIFICATE NUMBER: 2018AN Lines REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAVFD ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTIAITHSTANDING ANY REOUAEMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER OOCUTAENT VATH RESPECT TO VnCH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED EY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TER)AS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHowi A1AY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> Tra53i -..._.. .. _..__.... .. �R POLICY FOP -PO lCY>%P '. <br /> LTR TYPE OFNSURANCE I"Sn �yyp POMYNUNWER (kih!,DDIYYYY M0.1DDNYYYI LIMrTs <br /> COMlJERCIALGENERALLIABILITY EACHOGCU_RRENCE $DAMAG-'TO <br /> 1,000,0ff0 <br /> C[AYdS-Y.ADE QOCCUR PRFMJS-FS Ea(+ wre—A § 300,000 <br /> rJPD f9fP(Arc;era psrson) g 15,000 <br /> A 6042861810 OS101r2018 0810112019 PERSONAL&ADVINJURY $ 1,000,000 <br /> E - GIFNERALAGGREGATE 5 2,000,000 <br /> C�[;(1 A6GfrEGR.TEl€.L.€TRF#'LI_ S F•[R� <br /> ISPOLICY❑3ECT 1-1t4i; PRODUCTS-C NNOPAGG S <br /> 2,000,000 <br /> DTI,- __ S <br /> CCkVatn FD sutraE LIliJI- <br /> AUTOhlOB1LELIABILlTY IEaa:[kfef3 S 1,000,000 <br /> X ANYAUTO BODILY k41URY(PerPatsw) S <br /> A OMED -- SCHEDULED 6042E61807 08/01/2018 08101/2019 BODILY 114JURY(Per zccldudy 5 <br /> AITTOSONLY AUTOS <br /> HTRE-D NOaa WWEO F'ROY'ElkrYOAI:tACN, $ <br /> X AUTOS ONLY x AUTOS ONLY Prj;'a W-11 <br /> HAPD Med#Cal payments $ 6,1300 <br /> UMBRELLA iJAS OCCUR _ Lkcii OCCURRENCE g 9,000,000 <br /> B EXCESSMR CLaa, MADE 604286i824 0810112018 0810112019 AGGREGATE 5 %000,000 <br /> DED I x RETENTiCaa S 10,000 - <br /> YdORHERSCOMPENSATION 1ATUTE ORTH- <br /> AND ErAPLOYERVLIABILITY YIN <br /> ANY PROPRIETOWARTNEFUEXECtNIVE �[ NIA EL EACH ACCIDENT 5 <br /> OFFICEROIERiBER EXCLUDED? I <br /> (hiandatocylnNH) EL DISEASE-EAVAPLOYEE $ <br /> U)vs,des-rt vr;der <br /> DESCRIPTION OF OFERAMNS be'a,Y 1~LDISEA$Q-POLICY LIIJIT $ <br /> DE$CRIPTIO'd OF OPERATIONS!LOCAT10tiS/VEHICLES(ACORD 10i,Add6onal Remarks SChedure,may ho attaehad If mare space Is required) <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 /> PROOF OF INSURANCE ONLY ACCORDANCE%TH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATWEj <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 26(2016103) The ACORD name and logo are registered marks of ACORD <br />