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DocuSign Envelope ID:CC57DE94-E4EF-4D65-8035-F4F6E42CB4CC <br /> A n® CERTIFICATE OF LIABILITY INSURANCE °ATE`MM 06l11)2019 Y€ <br /> 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,EXTENT]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 pallcy(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 an <br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTA Diane Nadeau <br /> NAME: <br /> Business Insurers of Carolinas PHONE (g19}968-4611 FAX (919)968-8991 <br /> AIC No Ext: AIC No <br /> 8GO Eastowne Drive,Suite 208 E-MAILdnadeau@business-insurers.com <br /> ADDRESS: <br /> PO Box 2536 IN SURERIS)AFFORDING COVERAGE NAIL# <br /> Chapel Hill NC 27516-2536 INSURERA: American Liberty Insurance Cc 25186 <br /> INSURED INSIJRER13: Employers Mutual Casualty 21415 <br /> DISPUTE SETTLEM ENT CENTER INC WSURERC: <br /> 302 W WEAVER ST STEA INSURER D: <br /> INSURER E: <br /> CARRBORO NC 27510-6004 INSURERF: <br /> COVERAGES CERTIFICATE:NUMBER: 19-20 REVISION!NUMBER: <br /> THIS IS TO CERTIFY THATTHE 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 V41TH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE I NS U RANC E AF FO RD ED 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 /> ILTR ADDLISUORI POLICY EFF POLICY P LIMITS <br /> TYPE OF IN POLICY NUMBER MMIDDIYYYY MMIDDIYYYY <br /> X COMMERCIALGENERALLIABILITY EACH OCCURRENCE $ 1,000,000 <br /> D 300,000 <br /> CIAIMS-MADE FX-1 OCCUR PREMISE Es ocarrrenca S <br /> MED EXP Any one arson S 5,000 <br /> A 4W54487 06/17/2019 06/17/2020 PERSONAL&AOV INJURY S <br /> GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000.000 <br /> X POLICY E PE° LOC PRODUCTS-COMPIOPAGG $ 2,000,000 <br /> OTHER: Hiredlhcrrowed $ 1,000.000 <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> Ea accident <br /> ANYAUYO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Par accident <br /> $ <br /> UMBRELLA LIAB OCCUR EacH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DIED RETENTION$ $ <br /> WORKERS COMPENSATION <br /> AND EMPLOYERS'LIAfi1L[iY STATUTE ER <br /> ANY PROPRIETORIPARTNERIEXECUTIVE YIN E.L.EACH ACCIDENT $ 100,0G0 <br /> B OFFICERIMEMBEREXCWOED4 NIA 4H54487 08177l2G19 0611712D20 <br /> (Mandatory In NH) E.L DISEASE-EA EMPLOYEE E 100,000 <br /> It yes,dascrIba under 600,0130 <br /> OESCRIPTION OF OPERATIONS below L E.L.DISEASE-POLICY LIMrr $ <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY Of THE ABOVE DESCRIBED POLICIES BE CANCELI-ED BEFORE <br /> THE EXPIRATION DATE THEREOF,NOTICE WILL BF DELIVERED IN <br /> Orange County Government ACCORDANCE WITH THE POLICY PROVISIONS. <br /> PO Box B 181 <br /> AUTHORIZED REPRESENTATIVE <br /> Hiilshorough NC 27278 ��_ <br /> C 1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD <br />