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DocuSign Envelope ID: D5386F95-C7D7-4467-802E-832D3E20CE67 <br /> DATE(MMIODIYYYY) <br /> CERTIFICATE OF LIABILITY INSURANCEF812512018 <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 policyties]must have ADDITIONAL INSURED provisions or be endorsed. <br /> If SUBROGATION 1S 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{sl. <br /> PRODUCER CONTE c`r Tiffany Davenport <br /> NAMBB&T Insurance Services, Inc. PH°NE 804�78-5027 rA1xc No:888-751-3010 <br /> 2108 W.Laburnum Ave Suite 300 E-MAIL <br /> PO Box 17370 ADDREss: tdaven art bbandt.com <br /> Richmond VA 23227 INSURERS AFFORDING COVERAGE NAIC9 <br /> INSURERA:Valley Forge Insurance Company 20508 <br /> INSURED 35SMEINC INSURER B:Continental Insurance Com a ny 35289 <br /> Inc. <br /> 3201 Spring Forest Rd. INSURER c:Travelers Property Casual Co of Amer 25674 <br /> 3201 <br /> Raleigh, NC 27616 INSURER 0:American Casua Ity CD of Reading PA 20427 <br /> INSURER E;XL Specialty Insurance Company 37885 <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 /> INSR I TYPEOFINSURANCE ADOLSUBR POLPOLICYNUMBER MMDIDY EFF NYYY PMIDDffY� LIMITS <br /> LT <br /> A X COMMERCIAL GENERAL LIABILITY Y Y 6042844344 7/1/2016 7/1/2019 EACH OCCURRENCE $1,M0,000 <br /> CLAIMS-MADE �OCCUR REMISES A a $1,000 D0O <br /> MED EXP oneperson) $15,000 <br /> PERSONAL&ADV INJURY $1,000,000 <br /> GEUL AGGREGATE LIMIT APPLIE$PER: GENERAL AGGREGATE $2,000,U00 <br /> POLICY[K jE'G'T FX]LOG PRODUCTS-COMPW AGG $2.000.000 <br /> OTHER: $ <br /> B AUTOMOBILE LIABILITY Y Y 6042844313 7MOMB 71V2019 COMBINEDSINGLELIMIT S1,00D,000 <br /> Ee Nde.1 <br /> XI <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ONMED SCHEDULED BODILY INJURY PeracddeM $ <br /> AUTOS ONLY AUTOS <br /> HIRED X NON-OWNED PROPERTY DAMAGE S <br /> AUTOS ONLY AUTOS ONLY Per sodden[ <br /> $ <br /> C X UMBRELLALIAB }( OCCUR Y Y ZUP51MB239518 7111201B 7/102019 EACH OCCURRENCE $5,000,ODO <br /> EXCESS WAS CLAIMS-MADE AGGREGATE $5,000,000 <br /> DED X I RETENTIONS in coo $ <br /> 0 WORKERS COMPENSATION Y W0642647965 W112018 Tf1aG19 X PER OTH- <br /> AND EMPLOYERS'LIABILITY YIN STATUTE ER <br /> ANYPROPRiETORIPARTNERIEXECUTIVE N f A E.L.EACH ACCIDENT $1=000 <br /> OFFIGERRrtEMBER ExCLUDE07 <br /> (Mandatory In NH] EL.DISEASE-EA EMPLOYEE $1,000,OW <br /> IF yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT 51,000,000 <br /> E Professional Liability OPR9927327 7/1/2018 71i=19 5,000,DOD PerClalrn <br /> Including Pollution 5,0M,060 Aggregate <br /> DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is requl red I <br /> Umbrella policy extends over General Liability,Automobile Liability and Employers'Liability coverages. <br /> In the event that the Company cancels the General Llability,Automobile Liability or Employers'Llability policies for 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 Professional Liability pulley 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 Whom the NAMED INS URfnD 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 THERECIP, 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 REPRESENTATIVE <br /> PO Box <br /> 8181 <br /> Hillsborough NC 27278 <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD <br />