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DocuSign Envelope ID: F6E5B15D-6611-4749-BBCF-56530F14FFBD
<br /> DATE I MMM DIYYYY)
<br /> AC"J?"® CERTIFICATE OF LIABILITY INSURANCE
<br /> 612512018
<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 PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)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 CQNTACT
<br /> NAME: Tiffany Davenport
<br /> BB&T Insurance Services, Inc. PHONE Fax
<br /> 2108 W.Labumum Ave Suite 300 .804-678-5027 C Ho:888-751-3010
<br /> PO Box 17370 E DRESS. tdavenpart@bbandt.com
<br /> Richmond VA 23227 1 NSUREMSJ AFFORDING COVERAGE NAIC#
<br /> INSURERA-Valley Forge Insurance Company 20508
<br /> INSURED 35SMEINC iNsuRERs:Continental Insurance Com pany 35289
<br /> S&ME Inc.
<br /> 3201 Spring Forest Rd. INSURERC:Travelers Property Casualty Co of Amer 25674
<br /> Raleigh,NC 27616 INSURER0:American Casuapy Co of Reading PA 20427
<br /> INSURERE:XL S ecia Ity Insurance Cam pany 378$5
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:1573430642 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 IS SUBJECT TO ALL THE TERMS,
<br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> ILLTTRR TYPE OF INSURANCE ADBLSUBR POLICY NUMBER POLICY EFF MDD1YYYY MMID Y£XP LIMIT'S
<br /> A X COMMERCIAL GENERAL LIABILITY Y Y SD42844344 7711281 E 711rt019 EACH OCCURRENCE $i,000,000
<br /> CLAIMS•MADE F-k1 OCCUR PREMISES(Ea oodi a ce $1,000,D00
<br /> MED EXP one rson) $15,000
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> POLICY El PRO-
<br /> POLICY T Fx]LOG PRODUCTS-COMPIOP AGG $2.000.000
<br /> OTHER: $
<br /> B AUTOMOBILE LIABILITY Y Y 6042844313 7111201E 7711201E C.OMEINEDSINGLELIMIT $1,000,00o
<br /> IX
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> OVWJED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> HIRED X NON-OWhIEU PROPERTfDAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per acdderd
<br /> $
<br /> C X UMBRELLA LIAB N
<br /> OCCUR Y Y ZUP51ME239518 711I2018 7N12019 EACH OCCURRENCE $5,000,000
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000
<br /> ❑E❑ I X RETENTION$ s
<br /> WORKERS COMPENSATION Y %AC842647985 7/10018 711)2019 X
<br /> AND EMPLOYERS'LIABILITY YIN I STATUTE ER
<br /> ANYPROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT s 1,000,000
<br /> OFFICERIMEMBER ExCLUDED7 F7N N 1 A
<br /> tMandatery m NHl E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L,DISEASE-POLICY LIMIT $1,0D0,000
<br /> E ProresslnnalLiabillty DPR91127327 71WO18 71V12019 5,000,000 Per Claim
<br /> lnctudfng Pollution r 5,00o,DOD Aggregate
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORO 101,Additional Remarks Schedule,may be attached 11 more apace Is requlred)
<br /> Umbre€la policy extends over General Liability,Automoblle Liability and Employers'Liability coverages.
<br /> In the event that the Company cancels the General Liability,Autom DID ite Liability or Employers'Liability policies far any statutorily permitted reason other than
<br /> non-payment of premium,the Company agrees to provide ninety(90)days notice of cancellation of the Policy to any entity with Whom the NAMED INSURED
<br /> agreed in a written contract or agreement would be provided with notice of cancellation of the policy,
<br /> In the event that the Company cancels the P role ssianaI Liability policy for any statutorily permitted reason other than non-payment of premium,the Company
<br /> agrees to provide thirty(30)days notice of cancellation of the Policy to any entity with Wham the NAMED INSURED agreed in a written contract or agreement
<br /> See Attached...
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Dept.of Environment,Agriculture, Parks and Recre ACCORDANCE WITH THE.POLICY PROVISIONS.
<br /> Attn:Thomas Davis
<br /> 306 A Revere Road AUTHORIZED REP RESENTATIVE
<br /> PO Box
<br /> 8181
<br /> Hillsborough
<br /> INC 27278
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
<br />
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