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DocuSign Envelope ID:84C16365-07DD-47CB-A641-AC21B06B3B83 <br /> AC 0) CERTIFICATE OF LIABILITY INSURANCE DATE[MMIDOIYYYYI <br /> 1 09/26/2019 <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 endorsements. <br /> PRODUCER NTACT Lar F HodCs <br /> NAME: nr 9 <br /> Ai insurance PRONE+ o ENO: 2SZ-937-281fi i Ny 252-937-6i3o1 <br /> s <br /> PO Box 2444 ADDRIESS, larryhodges@aiins.us <br /> INSURER($)AFFORDING COVERAGE NAIL/ <br /> FAYETTEVILLE NC 28302 INSURERA: Mt Hawley Insurance Co. <br /> INSURED INSURER B: Mt Hawley Insurance Co. <br /> FIRST FIRE PROTECTION INC 114SURER C.: Integon General Insurance CO. <br /> p0 BOX 10594 INSURER D: Travelers Property Casualty Co.of America <br /> INSURER E! <br /> RALEIGH NC 27605-0594 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 INSURANCEDDLNUBR. POLICY EFF POUCY EXP <br /> LTR MS' POLICYNUMBER D MMIDDIYYYY umrrs <br /> X COMMERCIAL GENERAL LIABILITY +EACH OCCURRENCE S 1,000,000 <br /> CLAIMS-LIADE X. OCCUR DAMAGE TO RENTtry 100,000 <br /> PREMISES�Fa ocwrrenoa S <br /> MED EXP(Any one person) $ 5,000 <br /> A x X PGA0003445 09/05/2019 09/05/2020 PERSONAL 8ADVINJURY S 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 <br /> x POLICY F71 JECT L4C PRODUCTS-COMPIOP Ar3G S 2,v00,000 <br /> OTHER W S <br /> AUTOMOBILE LIABILITY CO UN INGLE LIMIT S 1,000,000 <br /> _E{ Wdent} <br /> ANY AUTO BODILY INJURY(Per person) S <br /> C OWNED K SCHEDULED <br /> AUTOS ONLY AUTOS AU7pS x x 2004999809 05/08/2019 05/08/2020 BODILY INJURY(Per accident) S <br /> HIRED 110N-OWNE11 PROPERTY DAMAGE S <br /> AUTOS ONLY AUTOS ONLY Per acctdenI)--_- _ <br /> MEDICAL PAYMENTS s 1,000 <br /> UMBRELLALIAB X OCCUR EAC HOC CURRENCE S 2,000,000 _ <br /> B rJ( EXCESS LIAR CLAIMS-MADE XGA00o)548 09/05/2019 09/05/2020 <br /> AGGREGATE S 2.000.000 <br /> BED RETENTION$ PRODUCTS COMPLETED S 2,000,000 <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY YIN LSTA UTE ER <br /> D OFFCERIMEMB EMBER U ED?EGUTIVEF7Y NIA 6JUB-I 54855-0-19 08/15/2019 08/15/2020 E.L.EACH ACCIDENT $ 500,000 <br /> {Mandatory in NH) E-L-DISEASE-EA EMPLOYEE $ 500,000 <br /> II yyes,descn a under --- <br /> DESCRIPTION OF OP!_RATION 116elaw E-L DISEASE-POLICY LIMIT S 500.000 <br /> null <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 /> Orange County,NC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> PO Box 8181 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Hillsborough NC 27278-8181 AUTHORIZED REPRESENTATIVE <br /> LARRY F HODGE5 j cc <br /> CA 1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD <br />