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DocuSign Envelope ID: 109A31BO-29AD-4F2B-8257-8D55D4FF0808 <br /> DATE IMMMD1YYYYy <br /> ALA�® CERTIFICATE OF LIABILITY INSURANCE <br /> 2/20/2020 <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 polley(les)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 Tiffany Davenport <br /> FA]( <br /> MCGriff Insurance Services PHONE <br /> 210t3 W. Laburnum Ave Suite 300 E,o•804-678-5027 a•888-751-3010 <br /> PO Box 17370 daFs • tdavenpart@mcgriffinsurance.com <br /> Richmond VA 23227 INSURE S AFFORDING COVERAGE NAICN <br /> INSURER A.Valley Fore Insurance Company 20508 <br /> INSURED MIME= INSURERS.Travelers Prop"Casualty Co of Amer 25674 <br /> S&ME Inc. <br /> 3201 Spring Forest Road INsuRERc:XL Specialty Insurance Company 37885 <br /> Raleigh, NC 27616 INSURER D:American Casualty Co of Reading PA 20427 <br /> INSURER E- <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:1141073706 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 VATH 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 /> ILTR NSR ADDLICYEXP <br /> TYPE OF INSURANCE I=WVD SUER POLICY NUMBER PWDDfY`YY EFF MMIDDNYYY LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY Y Y 6042844344 711=19 7/1/2020 EACH OCCURRENCE $1,DDO,000 <br /> AGE TO <br /> CLAIMS-MADF M OCCUR PREMISE EaENTED occurrence $1,00D,000 <br /> MED FXP tAmy one rson) $15,000 <br /> PERSONAL&ADV INJURY $1.000.000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER, GENERAL AGGREGATE $2,000,000 <br /> POLICY[R]JECT LOC PRODUCTS-COMPIOPAGG $2,000,000 <br /> OTHER: S <br /> A AUTOMOBILE LIABILITY Y Y BUA6042844313 7l112019 7/1/2020 COMBINED SINGLE LIMIT $1,000.000 <br /> Ea accident <br /> )( ANY AUTO BODILY INJURY(Per person) $ <br /> 'OWNED SCHEDULED BODILY INJURY[Per accident} $ <br /> AUTOS ONLY AUTOS <br /> x HIRED X NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY War accident <br /> $ <br /> B )( UMBRELLA LIAEI N OCCUR Y Y ZUP51MB239519 7/1/2019 7/1/2020 EACH OCCURRENCE $5.000,000 <br /> EXCESS LIAR CLAIMS-MADE AGGREGATE $5,000,000 <br /> DED I x RETENT]ON$in nn n I $ <br /> D WORKERS COMPENSATION Y WC678651782 7/1/2019 7/1/2020 x STATUTE ERH <br /> AND EMPLOYERS'LIABILITY <br /> ANYPROPRIETORfPARTNERIEXECJTIVE YIN N f A E.L.EACH ACCIDENT $1.000,000 <br /> OF F IC EWM EMBER E7(CLUOED7 <br /> [Mandatory In NHl E.L.DISEASE-EA EMPLOYEE S 1,D00,00D <br /> If ea,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 <br /> C Prolessional Liability OPR9944512 7/1/2019 7/1/2020 5,000,000 Per Claim <br /> ha'luding Pollution 5,000,0m Aggregate <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more apace Is requlredl <br /> Umbrella policy extends over General Liability,Automobile Liability and Employers'Liability coverages. <br /> In the event that the Company cancels the General Liability,Automobile Liability or Employers'Liability policies for any statutorily permitted reason other than <br /> non-payment of premium,the Company agrees to provide ninety(90)days notice of cancellation of the Policy to any entity with Whom the NAMED INSURED <br /> agreed in a written contract or agreement would be provided With notice of cancellation of the policy. <br /> In the event that the Company cancels the Professional Liability policy for any statutorlly permitted reason other than non-payment of premium,the Company <br /> agrees to provide thirty(30)days notice of cancellation of the Policy to any entity with Wham the NAMED INSURED agreed in a written contract or agreement <br /> See Attached... <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY Of THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Dept. of Environment,Agriculture, Parks and Recre ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Attn:Wesley Poole <br /> 306 A Revere Road AUTH ORME D REP RESENTATIVE <br /> PO Box Hillsborough <br /> NC 27278 <br /> ©1988-2016 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD <br />