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DocuSign Envelope ID: BF09D2E9-7297-41322-8360-A1 E6CO73ECAF <br /> FDATE(MMlDDlYYYY} <br /> -4�v> CERTIFICATE OF LIABILITY INSURANCE 0312812019 <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 /> Marsh USA Inc. NAME' <br /> PAX <br /> CA Non-Resident No A1CNNo 0322B89 Ext: (AJC No: <br /> 100 North Tryon Street,Suite 36M E-MAIL <br /> Charlotte,NC 28202 ADDRESS: <br /> INSURERS AFFORDING COVERAGE _ NAIC 4 <br /> CN1 01 388530-S.P.C-CAS.A-1 8-19 INSURER A:ACE American Insurance Company 22667 <br /> INSURED 35300 <br /> Sunoco Products Company INSURERS;Allianz Global Risks Us Insurance Company <br /> All Subsidiaries and Divisions INSURER C:ACE Fire Underwriters Cc 20702 <br /> Mail Code 1315 INSURER D: <br /> one North Second Street - <br /> HartSville,SC 29550 INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: ATL-004927800-01 REVISION NUMBER: 4 <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 ADDLTYPE OF INSURANCE INSO SUER POLICPOLICY NUMBER MMIDBY EFF MOMLDDY EXP LIMITS <br /> LTR <br /> A X COMMERCIAL GENERAL LIABILITY XSLG,71213134 10101018 1010112019 EACH OCCURRENCE $ 1,500,000 <br /> DAMAGE TO RENTED Incl.in SIR <br /> CLAIMS-MADE OCCUR PR3=MiSES Ea occurrence $ <br /> MED EXP(Any one person) $ Incl.in SIR <br /> PERSONAL&ADV INJURY $ 1,500,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE S 25,000,000 <br /> X POLICY�� PRO- LCC PRODUCTS-COMPIOP AGG $ 1,500,C00 <br /> OTHER: Excess ai$500,000 51R $ <br /> BINED SINGLE LIMIT <br /> A AUTOMOBILEI.IABILITY <br /> ISAH2570940 1010112018 1010112019 COEaM $ 2,000,000 <br /> accident <br /> X ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Peracadent) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> X UMBRELLA LIAR X OCCUR USL00102218 10/0112018 1010112019 EACH OCCURRENCE $ 4,000,000 <br /> EXCESS LIAR CLAIMS-MADE AGGREGATE $ 4,000,000 <br /> 0E6 RETENTION$ $ <br /> A WORKERS COMPENSATION WLRC65225256 (AOT)__T072F19 �1010112019 X PER OTH- <br /> AND EMPLOYERS'LIABILITY STATUTE ER <br /> C Y r N SCFC65225293 (Wi) 10/01I2018 10/0112019 Q90 0Qp <br /> ANYPROPRIETOR/PARTNERlEXECUTiVE E.L.EACH ACCIDENT $ <br /> OFF'ICERIMEMBEREXCLUDED? � N 1 A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,ODD,00D <br /> if yes,describe under I E.L.DISEASE-POLICY LIMIT $ 1,0D0,000 <br /> .DESCRIPTION OF OPERATIONS below <br /> A EXCESS WORKERS COMPENSATION WGUC65225335 (OH,SC,WA) 10101/2018 10lo112019 WC STATUTORYIEMPLOYER LIAR $1,0M,000 <br /> EXCESS$750,000 SIR <br /> i <br /> DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Orange County North Carolina is included as additional insured as its interest may appear and only as required by written contract subject to the policy terms and conditions,except for workers compensation.A <br /> waiver of subrogation is included under Workers Compensation in favor of the additional insured,if required by written contract with the named insured,subject to the terms and conditions of the poiicy. <br /> CERTIFICATE HOLDER CANCELLATION <br /> Orange County North Carolina SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> 200 South Cameron Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> PO BOX 8181 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Hillsborough,NC 27278 <br /> AUTHORIZED REPRESENTATIVE <br /> of Marsh USA Inc. <br /> Karen A.Burke - Qc 61c,. 1�k_� <br /> ©1988-2016 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD <br />