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DocuSign Envelope ID:8CFODBE7-8B79-49E2-92BC-06D4EO10765E <br /> ERTIFf TE F LIABILITY IN IDATL(11"DWrryyI <br /> U R N E ros�zo� <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RJGHTS UPON THE CERTIFJCATE HOLDER, THIS <br /> CERTIFICATE DOES NOT AFFIRMATlVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDZ J;l BY THE POLICIES <br /> BELOW- THIS CERTIFICATE OF INSURANCE DOES NOT CONST#TUTE A CONTRAc7 BETWEEN THE ISSUING INGURER(S), AUTHOR 7J=-D <br /> REPRESENTATfVE OR PRODUCER,AND THE CERTIFICATE HOLDER- <br /> IMPORTANT: If the certificate holder is an ADDITIOkAt,INSIfRftl,the POIIcYjies}must#1e endorsed. 9 F'-rJ5R0GA71Qlq I.S WAIVED,subject to the <br /> terms and randRIcF s of#hc policy, certain Policies may require an andorsamor& A statement on this C9rttfiiaate does riot confer rights to tl,e <br /> certificate holder In lieu of such endoraeFncngr.)- <br /> pR4LkICER Greg LOPeMan, CPCIJ whir - Gres Lap�m-lan <br /> StM Farm InSorance �fAx <br /> PH4IE EKtI $13�- � J 1+'LlCtNoF:919= ..'3- t <br /> 104-B N Hwy 54 Aa�IopEAS GFO-g,L2pemarl taam ayr <br /> arrboro, NC 27510 _ PMuRM%L3 AFFORDINGCOVERAGE _ nruolt <br /> IwsuREl�a:Sk�le Fame Fire ana Gasua Com ry _ 43 <br /> IH3LIRF,p RILEY SU RVEY1 NG PA W&UF9CR B: B Farm M*Vai AuwrnDeile 1rr3Uranaa co!np" � <br /> STE 100B laatllm7c <br /> 3326 DURHAM CHAPEL HJI L SLVD INSURER <br /> DJ_JRHAM NC 27707- 695 <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS JS TO CERTIFY THAT FHE POLICIE$ OF 1NWRANQE LISTED BELOW HAVE BEEN ISSUED To THE INSURED N MED ABOVE FOR THE POLICY PERIOD <br /> INDICATEQ- NOTVIITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CchITRACT OR CTHER DOCUmEuT Wrr" RESPECT TO WLIICH THI$ <br /> CERWICATF MAY BE ISSUED OIL MAY PERTAIN, IME INSURANCE AFFORDFJ) BY THE POLICII±S DESCRIBED HEREIN I$ SUBJECT TO ALL THE TERMS. <br /> E%Q,USIOHS ANQ CONDrTIONS QF$UCH POLICIES,LItwTS S11CWH MAY HAVE BEEN REDUC;I"Q Sy PAID CLAIMS, <br /> NSR TYPE flF tli8'URgFpE DOL 3U—iR PO�IGT EFF ��w <br /> - <br /> POL ICY NUMBER y�6 <br /> FGL-AIM3-WDE <br /> L1A6rnY y ❑I �a G-Z005$ 0=201$ NCE MERpIaLGE➢IE'FWLLIl�$ILnYagrm� OCCLIR �Per�sn�Att-ADV INJURY _ S <br /> GENERALAGOMCATE 5 �,000.o p <br /> GEr1L AGGREGATE LIMIT APPiIEfi PER! FROUM;=0OMPY01"AGG S 2ri)00.004 <br /> PoLkl Y _P B . 4CG <br /> 071 I LE LIMITAUTOMOMLE LfAMLRY mrti <br /> s <br /> AWAUTO BODLYia,JLIRYFerpur p 3 500,0D0 <br /> A+JLT06++EQ SCIAEDLILAUTOS ED KOK'(twLRY;Per ma:2dwTo S 54U,IX10 <br /> HIRED AUTOS }( NON-U%%F.4 <br /> AUTOS <br /> S 1M.000 <br /> 5 <br /> A UFIBRPLLAL►A OCCUR F+r`H 0(,`(,`WT1310E, € 1,004,000 e��re-1111-1 n8iyoi�ats 081101�0�9 . <br /> 0r.933 Ltw CLAIMS-MIADE — �.. <br /> AGGREGATE # 1,000-40 <br /> .Fn 11T1-I1EUN5 10,OUQ <br /> A 1WORKERSCOMPENSAMON WCSW OTFF 5 <br /> AhD EMPLUTE"LUWW TY T Fi <br /> AFlS'PaprR�-fC4.PAF§THER?EXECiITIVE EL.EACHh IPENT _ # i,44G,pp0 <br /> OFnCkvWEµBEREXCLUDED1 MBA 93�CV-Rdfi3 3 0202012011) 02r'20i2d�� - <br /> 4f Ns.doscr Im f{ryF E.L DBEASE-Ea EMI-0Y E S 1,pLTQ,ppO <br /> Jf yes,dos�rit�r prQgr <br /> p I E.L DIS€W-PC*ICY LIMIT ,S 1,OQ¢,gk1q <br /> tXSCRW TIOH OF OPF PL'n0N5 a LOCATIONS a wEHICLES{Anadh ACORD 10f,Ad&uonm FtAMj *a Scheduld,II mor9 Spam is raquirad) <br /> CERTIFICATE HOLDER CANCELLATION <br /> Orange County $HOULD AW1 TFip A50VE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EMPI T N DAT$ THEREOF, �1OME VWLL BE DELIVERED IN <br /> PO Box 8181 ACCoROA E w�t,Trir=POLKY PROVISION$- <br /> Hillsborough, NC 27278 y <br /> MTrrDIUMD ENTA <br /> �0 1988-2010 ACORD COIF? T N9 All rights reserved. <br /> ACORD 25{2010JQ5) The ACORD dame and logo are registered marks of ACORD i-o14B6 1328-09.6 <br />