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DocuSign Envelope ID: F772F57D-CDB6-49D8-AED6-68B334B4C6C6 Page 1 of 2
<br /> A��0 DATE(MM/ Y)
<br /> CERTIFICATE OF LIABILITY INSURANCE 03/22/201/2019
<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(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 CONTACT
<br /> NAME:
<br /> Willis of Tennessee, inc. DBA Willis of South Carolina PHONE 1-877-945-7378 FAX 1-888-467-2378
<br /> c/o 26 Century BlvdWC,
<br /> C No Ext: A/C No):
<br /> E-MAIL P.O. Box 305191 ADDRESS: certificates@willis.com
<br /> Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURERA: Zurich American Insurance Company 16535
<br /> INSURED INSURER B: American Guarantee and Liability Insurance 26247
<br /> Bonitz Flooring Group, inc.
<br /> 10701 World Trade Blvd INSURERC: AIG Specialty Insurance Company 26883
<br /> Raleigh, NC 27617 INSURERD: Columbia Casualty Company 31127
<br /> INSURERE: Travelers Property Casualty Company of Ame 25674
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:W10560886 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
<br /> LTR IN SD WVD POLICYNUMBER MM/DD/YYYY MM/DD/YYYY
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000
<br /> RENTED
<br /> CLAIMS-MADE � OCCUR PREMISES(DAMAGE ToEa occurrence)
<br /> ccurrrence) $ 1,000,000
<br /> A X XCU Included MED EXP(Any one person) $ 10,000
<br /> Y Y GLO 8343873-23 04/01/2019 04/01/2020 PERSONAL&ADV INJURY $ 2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000
<br /> POLICY� PRO- � LOC PRODUCTS-COMP/OP AGG $ 4,000,000
<br /> OTHER: $
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
<br /> Ea accident
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> B OWNED SCHEDULED Y Y BAP-8343872-23 04/01/2019 04/01/2020 BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> X HIRED X NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> B X UMBRELLALIAB I X OCCUR EACH OCCURRENCE $ 10,000,000
<br /> EXCESS LIAB CLAIMS-MADE Y Y AUC 2791382-22 04/01/2019 04/01/2020 AGGREGATE $ 10,000,000
<br /> DIED X RETENTION$0 $
<br /> WORKERS COMPENSATION X PER OTH-
<br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER
<br /> A ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBER EXCLUDED? NO N/A Y WC 8343871-23 04/01/2019 04/01/2020 1,000,000
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> C Contractor's Pollution CPO 9528327 04/01/2019 04/01/2021 Each Loss $2,000,000
<br /> Aggregate Limit $2,000,000
<br /> Deductible/SIR Amoun $ 25,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Certificate Holder and all other parties are named as additional insureds under the General Liability for ongoing and
<br /> completed operations, the Auto Liability and Umbrella Policies when required by written contract. The General
<br /> Liability, Auto Liability and Umbrella policies are Primary and Non-Contributory in favor of the Additional Insureds
<br /> when required by written contract. Waiver of subrogation is included with regards to General Liability, Auto
<br /> Liability, Workers Compensation and Umbrella Policies when required by written contract and permitted by law.
<br /> SEE ATTACHED
<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 /> AUTHORIZED REPRESENTATIVE
<br /> Evidence of Coverage A-- L]71 �J
<br /> ©1988-2016 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br /> SR ID: 17675254 13ATcx: 1122573
<br />
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