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DocuSign Envelope ID:234B0168-7DD8-4F95-A2D1-25D37F4A4C22 <br /> � N DATE(MMIDDIYYYY) <br /> AC"RL> CERTIFICATE OF LIABILITY INSURANCE <br /> ��. 03/1112019 <br /> THIS CERTIFICATE 15 ISSUED AS A NIATTER OF INFORlr1A71ON 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(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(s). <br /> PRODUCER CONTANAME' Carla Moore <br /> Colonial Insurance Agency Hillsborough A"oNNo,E (919)732 2191 FAX No: (919)732 2192 <br /> 103 Millstone Dr.Suite A EMAIL ADDRESS, .com <br /> caa colonial-a enc <br /> ADDRESS: ca0a@colonial-agency.com <br /> Y <br /> Po Box 490 INSURER 8 AFFORDING COVERAGE NAiC# <br /> Hillsborough NC 27278 INSURER ; Travelers Casualty Ins Co of America 19046 <br /> INSURED INSURER B <br /> 105 W Corbin Street LLC INSURER C <br /> 960 Corporate Dr INSURER D <br /> Suite 404 INSURER E <br /> Hillsborough NC 27278 INSURER IF <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. NOTW"STANDING 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 /> INSR ADOLSUBR POLICY E <br /> LTR TYPE OF INSURANCE INSD WVQ POLICY NUMBER (MWC)DrYYYY1 fMM1DDffYYYILIMITS <br /> X COMMERCIALGENERALLIABILITY EACH OCCURRENCE $ 1000000 <br /> TED <br /> CLAIMS-MADE X OCCUR PREMISES a occurrence $ 300000 <br /> MED EXP(Any orre person) $ 5000 <br /> A N N 680-4E778986-18-42 04/2112018 04/21/2019 PERSONAL a ADV INJURY $ 1000000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2000000 <br /> X POLICY PRO JECT LOC PRODUCTS-COMPIOPAGG $ 2000000 <br /> OTHFR $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> Ea accident <br /> ANYAUTO BODILYENJURY(Per person) $ <br /> OWNED SCHEDULED BODILYINJURY(Per accidenL) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED ROPERTY D AGE <br /> AUTOS ONLY AUTOS ONLY Peracc!deni <br /> U_ $ <br /> UMBRELLA LIAR OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB HCLAIMS-MADE AGGREGATE $ <br /> DE❑ I I RETENTION$ $ <br /> WORKERS CO MP ENSATH]N PR I <br /> AND EMPLOYERS'LIABILITY YIN STATUTE I IEROTH- <br /> ANY PROPRIETOR:PARTNEPJEXECUTIVE E.L.EACH ACCIDENT $ <br /> 0rPICER:MEMSER EXCLUDED? NIA <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ <br /> Iryes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> ❑ESCR3PTION Of OPERATIONS+LOCATIONS I VEHICLES (ACORD 101.Additional Remarks Schedule,may be attached if more space Is requiredl <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 /> Orange County, North Carolina ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Attn:County Manager <br /> PO Box 8181 AUTHORIZED REPRESENTATIVE <br /> Hillsborough NC 27278 <br /> Fax: Email, ©1988-2015 ACORD CORPORATION. Al rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACOR❑ <br />