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DocuSign Envelope ID:6287A96E-3D08-4E5A-829C-DA75D9AF2941 APPLTECHi
<br /> 411�.1 IL1r•�VI VV
<br /> ACORD. CERTIFICATE OF LIABILITY INSURANCE GATE{MMIDDIYYYY}
<br /> 1z1(MMIDD s
<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 1NSURER(S),AUTHORIZED
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policytiesy must have ADDITIONAL INSURED provlsions 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 any rights to the certificate holder in lieu of such endorsement(s).
<br /> PRODUCER NAME Cartrlrla Richey
<br /> Edgewood Partners Ins.Center HO H :878,478,3862 LAIC,No):
<br /> 2405 Satellite Blvd.,Ste.200 ADDRESS: cartrina.richey@epicbrokers.com
<br /> Duluth,GA 30096 INSURER(S)AFFORDING COVERAGE NAICS
<br /> 770 232-0202 Massachusetts Bay Insurance Company 22306
<br /> INSURER A: Y p Y
<br /> INSURED INSURER B:Hanover Insurance Company 22292
<br /> PENTA ENGINEERING GROUP,INC.,;A LeIAn ton Insurance ComPa Y 19437 n
<br /> INSURER C: 9
<br /> APPLIED TECHNICAL SERVICES,INC.;4000
<br /> INSURER D
<br /> MILLER COURT WEST
<br /> INSURER E:
<br /> NORCROSS,GA 30071 -
<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 MAY BE ISSUED OR MAY PERTA#N, 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 /> �NSR ADDL SUB POLICY EFF POLICY EXP
<br /> TR TYPE OF INSURANCE POUCY NUMBER IMUgD - @L4RD uM1T8
<br /> A x COMMERCIAL GENERAL LIABILITY ZDA9211365 7/15/2018 07/15/2019 EACH OCCURRENCE $1,000,000
<br /> CLAIMS-MADE 5XIOCCUR InCI.COntractual RNSIOEoruD
<br /> E a.ooeurD $1,000,000
<br /> X Prof/Pall MED EXP[Any one person] $10,000
<br /> C. 015719008 7/15/2018 07/15/201 PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: Claims Made GENERAL AGGREGATE 52,000,000
<br /> FRO-
<br /> x POLICY F_X1 JECT L=1 Lac $10,000,000 PRODUCTS-COMPIOPAGG s2,000,000
<br /> OTHER: $250,000 Ded. $
<br /> AUTOMOBILE ABT Eaa cdE°SINGLE LIAfTq cent 1,000,000
<br /> x ANY AUTO COmpIC011 ❑ed. BODILY INJ U RY(Per person) $
<br /> OWNED SCHEDULED AUTOS ONLY AUTOS $2 080 BODILY INJURY{Per accident] $
<br /> AUTOS ONLY �[ NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY Per ax dent
<br /> UNIM $100,000
<br /> B X UMBRELLA LIAB X OCCUR UHA9211368 7/15/2018 07/15/201 EACH OCCURRENCE $10 000 000
<br /> EXCESS LIAR CLAIMS-MADE Prof/Poll AGGREGATE $10 000 000
<br /> ❑EDTI RETENTIONS Not Included $
<br /> A WORKERS COMPENSATION WDA8801724 7/15/2018 07/15/201 ]C PER DTH-
<br /> AN❑EMPLOYERS'LIABILITY
<br /> ANY PROP RIETORIPARTNERfEXECUTIVE Y�N E.L.EACH ACCIDENT $1,000,000
<br /> OFFICERIMEMBER EXCLUDED? � NIA
<br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLtCY LIMIT $1 000 000
<br /> A Leased/Rented Equ ZDA9211365 0711512018 0711512019 $400,0001$1,000 Dad.
<br /> Replacement Cost Special Form
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space is required)
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> ORANGE COUNTY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> PO BOX 8181 ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> HILLSBOROUGH, NC 27278
<br /> AUTHORIZED REPRESENTATIVE
<br /> ©1988-2015 ACORD CORPORATION.All rights reserved.
<br /> ACORD 25(2016103) 1 of 1 The ACORD name and logo are registered marks of ACORD
<br /> #S13167971M1136690 TSTE2
<br />
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