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DocuSign Envelope ID:C3BD39CO-6CAO-4C46-9E28-269DE7DOAEEF <br /> DATE(MM/DDNWY) <br /> n�oKo CERTIFICA I r= vF LIABILITY INSURANCE <br /> ��. 7/31/2019 <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, 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 endorsoment(s). <br /> TA T <br /> PRODUCER NAME-,c Megan MCGIOhn <br /> JD Fulwiler&Co Ins PHONE FAX <br /> 5727 SW Macadam Ave (arc Nd Ext):503-977-5659 503-977-5859 <br /> Portland OR 97239 ADDRESS; mm4o)riffidfulwiier.corp <br /> INSURERS AFFORDING COVERAGE NAIC# <br /> INSURER A:National Fire Insurance Company of Hartford 20478 <br /> INSURED EXCEINC-01 INSURERB:Valley Forge Insurance Company 20508 <br /> Excellance Inc <br /> 453 Lanier Rd INsuRERc:The Continental Insurance Company 35289 <br /> Madison AL 35758 INSURERD: <br /> INSURER E: <br /> INSURER F <br /> COVERAGES CERTIFICATE NUMBER:855663284 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 PPAID CLAIMS. <br /> INJK TYPE OF INSURANCE <br /> LTR ADDL SUER POLICY NUMBER MM DD/YPOLICEYYY ` PNO�/00/YYYY LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY 6042861810 8/1/2019 8/1/2020 EACH OCCURRENCE $1,000,000 <br /> 1777 CLAIMS-MADE OCCUR PREMISE (Ea occurrence $300,000 <br /> MED EXP(Any one person) $15,000 <br /> PERSONAL&ADV INJURY $1.000.000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $2,000,000 <br /> X POLICY T LOC PRODUCT S-COMPIOPAGG $2,000.000 <br /> OTHER: $ <br /> B AUTOMOBILE LIABILITY 6042861607 8/1/2019 8/1/2020 COMBINED SINGLE LIM $1.000,000 <br /> E8 aee e. <br /> X ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS — <br /> HIRED NON-OWNED PRI�J'•'EI'T. .l7AMAGE $ <br /> X AUTOS ONLY X AUTOS ONLY <br /> X W0 Medical Payments $5,000 <br /> C X UMBRELLA LIAB X OCCUR 6042861824 8/1/2019 8/1/2020 EACH OCCURRENCE $9,000,000 <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $9,000,000 <br /> DED I X I RETENTION$jn nnn S <br /> WORKERS COMPENSATION <br /> STATUTE ER <br /> AND EMPLOYERS'LIABILITY <br /> ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E L EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? N/A <br /> (Mandatory in NH) E L.DISEASE-E.k FMPLGYEE S <br /> If yes,det cnbe 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 /> 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 /> PROOF OF INSURANCE ONLY <br /> USA AUTHORIZED REPRESENTATIVE <br /> I <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />