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DocuSign Envelope ID: D3DA07A7-1A7F-4208-86BE-6B8E692AA24F <br /> AC" R" DATE(MMIDDlYYYY) <br /> ii CERTIFICATE OF LIABILITY INSURANCE 1 0/2 512 01 9 <br /> THIS CERTIFICATE 1S 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 Jami McMillian <br /> NAME: <br /> $tateFarm GARY ELLIOTT AtCNo Est. 919-942-6057 Fo C No: 919-968-1948 <br /> 1805 E.FRANKLIN ST.STE 210 E-MAIL l p ami cha elhilisf.com <br /> DDRE55: <br /> CHAPEL HILL,NC 27514 INSURERIS)AFFORDING COVERAGE NAIC# <br /> INSURER A: State Farm Fire and Casualty Company 25143 <br /> INSURED INSURER B: <br /> KEENAN WILLIAMS INSURERC: <br /> 730 EAGLE POINT RD INSURER D <br /> PITTSBORO,NG 27212-6176 INSURER E: <br /> 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 I ADDLSUBRTYPE OF INSURANCE INSD WVD POLICY NUMBER MMl13DY EFF MM D2 EXP <br /> LTR LIMITS <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1.000,000 <br /> CLAIMS-MADE ®OCCUR PREM SESOEa occurrence $ <br /> MED EXP(Any one person) S <br /> 93-C1-MO04-7 09/11/2019 09M1/2020 PERSONAL&ADV INJURY $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> POLICY❑PRO ❑ <br /> JECr LOC PRODUCTS-COMPlOP AGG $ <br /> �9 OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> Ea accident <br /> ANY AUTO BODILY INJURY(Per person) S <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OVMVED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> UMBRELLA LIAR OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE] AGGREGATE $ <br /> 1)" RETENTION$ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY Yf STATUTE ER <br /> ANY PROPRIETOWPARTNERfEXECUTIVE ❑N F-L.EACH ACCIDENT $ <br /> OFFIGERIMEMBEREXCLUDED' NIA <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES (ACORD 161,Additional Remarks Schedule,may be attached If more space is required) <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 /> ORANGE COUNTY ACCORDANCE WITH THE POLICY PROVISIONS. <br /> P.O.BOX 8181 <br /> H AUTH ED REPRESENTATIVE <br /> ILLSBORDUGH,NC 27278 ��Puu)_, <br /> ©1998-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br /> 1001486 132649.12 03-16-2016 <br />