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DocuSign Envelope ID:A5F66F6C-3B2C-40FB-98B6-C183C558465E <br /> DATE(MMIDDIYYYY) <br /> �eafzQ� CERTIFICATE OF LIABILITY INSURANCE <br /> 1 01412 01 8 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE BOLDER.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(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 endorsement{sy. <br /> PRODUCER NAMEACT Lynne Meyer,CIC,CPEW,AINS <br /> Marsh&McLennan Agency LLC P1101111, .336-346.1302 we No):336-346-1397 <br /> 3625 North Elm St E-MAIL <br /> Greensboro NC 27455 ADDRESS: Lynne.Meyergmaishmma.com <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> __INSURER A:Builders Premier Insurance Company 13036_ <br /> INSURED BIRSI-2 INSURERS:Columbia Ca sua Ity Com pan 31127 <br /> .R, Inc.M IN SURER :Builders Mutual Insurance Com an 10844 <br /> Mr,Raven Br❑eker - <br /> PO Box 36197 INSURER 0: <br /> Greensboro NC 27416-6197 INSURERE; <br /> INSURER F <br /> COVERAGES CERTIFICATE NUMBER:1625434416 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 /> IE1SR ADDL SUER POLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE pWVD POLICY NUMBER Mmino MM RMOM LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY PCPOD03632 5111201 B 5/1/2019 EACH OCCURRENCE $1,000,000OA <br /> CLAIMS-MADE I X l OCCUR G ❑ E TED <br /> PREMISES Ea oocurrenoe $700400 <br /> MED EXP(Any One person) $5,000 <br /> PERSQNAL&AQV INJURY S 1,000,ODO <br /> GE HL AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $2,DOO,000 <br /> POLICY jECY 7 LOC PRODUCTS-COMPIOPAGG $2,000,000 <br /> OTHER: - --- S <br /> A AUTOMOBILE LIABILITY PGA0018423 5/1/2018 51MD19 COMBINED SINGLE LIMIT S 1,00D.Wo <br /> (Ea accldenf <br /> x ANY AUTO BODILY INJURY(Per person) S <br /> OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per aakfenl) $ <br /> X <br /> HIRED x NON-OWNED PAOPERTYDAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> Comptcoll Ded S 1,110011,000 <br /> O X UMBRELLA LIAR x OCCUR MUS0001296 511t201 B 5/1/2019 EACH OCCURRENCE $5,DOO,ODD <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $S,DDo,000 <br /> PEP 1 X RETENTIONS io--op S --- <br /> A WORKERS COMPENSATION PVVC100D200D8 &(W()18 51fI1019 x 3TATLITE ETH <br /> AND EMPLOYERS'LIABILITY Y)N <br /> ANYPROPRIETORIPARTNERMXECUTIVE ❑ N 1 A E.L.EACH ACCIDENT $1.000 000 <br /> RIM OFFICEEMBEREXCLUDED7 <br /> (Mandatory in NH) E,L.DISEASE-FA EMPLOYEE $1.000,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,OOD <br /> A Renlat Eqquuipment PCPODD3632 511/2018 S11r2018 16ROOD <br /> B E80IPoputlon CE0591855996 511120% 511R019 1,DOD,OOD <br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may ba attached If more 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 /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Orange County <br /> PO Box 85181 <br /> Hillsborough NC 27278 Au ORIZEDREPRE3ENTATE� <br /> 9)1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD <br />