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DocuSign Envelope ID:9F4A8CF5-2029-449B-A53F-956739F1CFD7 <br /> MATRI.1 <br /> CERTIFICATE OF LIABILITY INSURANCE DATE 0412912019YI <br /> `� 0412912019 <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)mast 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 endorsements. <br /> PRODUCER 252-438-8165 CONTACT Dan Wilson <br /> WESTER INSURANCE AGENCY PHONE 252-438-8165 FAX Z52,438-6ti40 <br /> 1020&GARNETT STREET Arc,No,Eat: No <br /> No <br /> RO.BOX 7fi9 ESS, ante esterinsurance.com <br /> HENDERSON,NC 27536.769 <br /> Dan Wilson INSU ER AFFORDING COVERAGENAIL <br /> INSURER A:Westchester Surplus Lines 10172 <br /> INSURED INSURERS:Auto-Owners Insurance Co. 19988 <br /> Matrix Health&Safety Consultants,LLC INSURERC:Hartford Insurance Co 22357 <br /> 2900 B Yonkers Road <br /> Raleigh,NC 27604 INSURERD: <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERT F CATE NUMB N 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 SUB POLICY NUMBER POLICY EFF POLICY FXP LIMITS <br /> A x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 2,000,000 <br /> CLAIMS-F,SADE OCCUR x x G24389091 04/1912019 04119/2020 DAMAGE TO RENTED S 300,000 <br /> _ MED EXP(Any one pgranni $ 10,000 <br /> PERSONAL&ADV INJURY 2,000,000 <br /> H'L AGGREGATE LIMIT APE PER; GENERAL AGGREGATE2,000,000 <br /> X POLICY jPCT LOC PRODUCTS-COMP P G 2,000,000 <br /> OTHER: <br /> COMBINED SINGLE LIMIT 1,000,000 <br /> B AUTOMOBILE LIARILrry <br /> JC ANY AUTO 5115326000 0411912019 04/1912020 BODILY INJURY Per arson <br /> ALTOS ONLY AUTOS <br /> ULED <br /> ii EE p pp B D L�Y�7NJURY Per accident <br /> OFOS ONLY A�OND Peraaccfd nt AMAGE <br /> UMBRELLA LIAR OCCUR EACH OCCURRENCE <br /> EXCESS LIAR El CLAIMS-MADE AGGREGATE <br /> DED I I RETENTION$ <br /> C WORKERS COMPENSATION X I PER D7H- <br /> ANOEMPLOYERS'LIABILITY 22WBCAB2FUC 02/09/2019 02109/2020 1,000,000 <br /> ANY PROP RIETORIPARTNERIEXECUTIVE N!A E.L EACH ACCIDENT <br /> ppW <br /> 1,000,000 <br /> {MandEatryn QEXCLUDED? E.L.DESEASE-EA EMPLOYE <br /> If s,describe under 11000,000 <br /> DESC ONS eaw <br /> A Professional Liab G24389091 64119/2019 04/19/2020 Prof.Lialb 2trtill2mil <br /> A Pollution Liab Poll Llab 2mill2rnii <br /> DESCRIPTION OF OPE RAT 10 NS I LOCATIONS I VEHICLES (ACORD 101,Addi Ilona Remarks Schedule,may be attached if more space Is requl red) <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 /> ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />