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DocuSign Envelope ID:8C590A3B-6E9F-4346-9B92-8EE62290ADCE <br /> —DATE IMM/C0/YYYYJ <br /> A ►�� CERTIFICATE OF LIABILITY INSURANCE 05/23/2018 <br /> PRUDUCER THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION <br /> Maguire Insurance Agency,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> Z7201PuertaReal Ste 200 HOLDER. THIS CERTIFICATE DOES NOT AMMEND, EXTEND OR <br /> Mission Vialo,CA9 2 69 1-7 3 89 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> 877.438.7459 <br /> INSURERS AFFORDING COVERAGE NAIL# <br /> INSURED INSURER A:Philadelphia Indemnity Insurance O=pany 18058 <br /> Martha Breda INSURERS: <br /> 138E MannsChapel Rd INSURER CI <br /> Pirtshora,NC27312.7030 <br /> INSURE R D: <br /> INSURER E: <br /> COVERAGES <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br /> ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERIFICATION MAY BE ISSUED OR <br /> MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH <br /> POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR ADD'L I POIJCYEFFECTIVE POLICY EXPIRATION <br /> LTR INSRO TYPE OF INSURANCE POLICY NUMBER DATE MWOD/YYYYJ DATE IMM/DD/YYYYI LIMITS <br /> A K GENERAL LIABILITY PHPK3071271- 08/05/2018 08/0S/2019 EACH OCCURENCE $1,000,000 <br /> T-MM ERCIAL GENERAL LIABILITY 005 PREMISES Ea occurrence $100,000 <br /> ADE � OCCUR MED EXP(Any one person) $2,500 <br /> FESSIONAL LIABILITY PERSONAL&ADV INJURY $1,000,000 <br /> GENERAL AGGREGATE $3,D00,000 <br /> GENT AGG REGATE U M IT APPU ES PE R: - PRODUCTS—COMP/OPAGG $3,000,000 <br /> 1( POLICY PROJECT n LDC <br /> AUTO M OBI LE LIABILITY COMBINED SINGLE LIMIT <br /> ANYAUTO TEA accident) <br /> ALL OWNED AUTOS BODILY INJURY <br /> SCHEDULED AUTOS (Per person) <br /> HIRED AUTOS BODILY INJURY <br /> NON-OWNEDAUTOS (Peraocldent) <br /> PROPERTY DAMAGE <br /> (Per accident) <br /> GARAGE LIABILITY AUTOONLY--EA ACCIDE NT <br /> ANY AUTO OTHER THAN EAACC <br /> AUTO ONLY: AGG <br /> EXCESS/UMBRELLA LIABILITY - EACH OCCURENCE <br /> OCCUR CLAIMSMADE AGGREGATE <br /> DEDUCTIBLE <br /> RETENTION <br /> EMPLOYERS'LIABIUTY Vito TDRY LIMITS ER <br /> ANY PROPRIETO,%PARTNERAXECUTIVE <br /> OFFICERIMEMBER CLUDED L—j E.L.EACH ACCIDENT <br /> (Mandatary In NH) E.L.DISEASE—EA AMPLOYEE <br /> if yes describe under <br /> SPECIAL PROVISIONS below E.L.DISEASE—POLICY LIMIT <br /> OTHER <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br /> 11 Is understood and agreed that the followl ng entity Is added as an add Rional Insured but only with respects)to the operations of the named Insured except that Ila bility resultlrsg from She additional insured's sofa <br /> negligence. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE <br /> Carol Woods RetirementCommunity THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE <br /> 750 Weaver Dairy Rd CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR <br /> Chapel Hill,NC 27514- LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES, <br /> AUTHORIZED REPRESENTATIVE <br /> ACORD 25(2009/01) ® 1988-2009 ACORD CORPORATION.All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />