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AC ® 708/1312019 <br /> E(MM/DD/YYYY) <br /> AC� CERTIFICATE OF LIABILITY INSURANCE <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 be endorsed. If SUBROGATION IS WAIVED, subject to <br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT <br /> NAME, Tonya Marsh Dawson <br /> Tonya A Marsh HONE No,Ext: 919-806-5109 ac No): 919-806-5310 <br /> E-MAIL md-a-gencyofficegogmail.com <br /> 5410 NC HIGHWAY 55 ADDRESS: <br /> STE M INSURER(S)AFFORDING COVERAGE NAIC# <br /> DURHAM NC 27713 INSURER A: NATIONWIDE MUTUAL FIRE INSURANCE COMPF 23779 <br /> INSURED INSURERB: AMTRUST NOTH AMERICA INC 524210 <br /> INSURER C: <br /> FUN 2 REF LLC INSURERD: <br /> 1105 INFINITY RD INSURERE: <br /> DURHAM NC 27712-9795 1 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 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 INSD WVD POLICYNUMBER MM/DD/YYYY MM/DD/YYYY <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> DAMAGE TO RENTED <br /> CLAIMS-MADE X OCCUR PREMISES Ea occurrence $ 100,000 <br /> MED EXP(Any one person) $ 1,000 <br /> A X ACID GLGO 2285150455 08/16/2019 08/16/2020 PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> X POLICY JE� LOC PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> Ea accident <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> NON-OWNED PROPERTY DAMAGE $ <br /> HIRED AUTOS AUTOS Per accident <br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 <br /> A EXCESS LIAB CLAIMS-MADE ACP CAF 2285150455 08/16/2019 08/16/2020 AGGREGATE $ 1,000,000 <br /> DIED RETENTION$ $ <br /> WORKERS COMPENSATION WC329236810134826 08/30/2019 08/30/2020 X STATUTE ERER H <br /> AND EMPLOYERS'LIABILITY Y/N <br /> B ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? ❑ NIA <br /> loolono <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> ADDITIONAL INSURED 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 /> ORANGE COUNTY AUTHORIZED REPRESENTATIVE <br /> PO BOX 8181 Tonya Marsh Dawson <br /> HILLSBOROUGH NC 27.278 <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br />