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DocuSign Envelope ID: F95C199F-F97E-472F-8EC3-1F88449C7DC7 <br /> DATE IMMrDDIYYYY} <br /> ACC>lv CERTIFICATE OF LIABILITY INSURANCE <br /> 1 011 412 0 1 9 <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 poi€cy(ies)must have ADDITIONAL INSURED provisions or be endorsed. <br /> if SUBROGATION 1S 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 /> CONTACT Susan Denton <br /> PRODUCER NAME: <br /> John Hackney Agency of Rocky Mount PHONE (252)442-3186 AIC <br /> C No No; (252)451-9400 <br /> 950 Country Club Road ADDRESS: sdentan@jharm.com <br /> P.O.Box 7807 INSURER(SI AFFORDING COVERAGE NAIC A <br /> Rocky Mount NC 27804-0807 INSURERA: Selective Insurance Co.of America(A)rated 12572 <br /> INSURED INSURER B; Accident Fund National Ins.Co of America(A)rated 12305 <br /> Seegers Fence Co,Inc,of Durham INSURER C: <br /> PO Box 61378 INSURER D: <br /> IN SURER E: <br /> Durham NC 2T116 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: C0 9 7 20421 6 REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED 8ELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INOICATED. NOTWITHSTANDI NO ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY 8E ISSUED OR MAY PERTAIN,THE I NSURANCE AFFOR DED 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 J ADDL5UHH. POLICY EFF POLICY LIMITS <br /> LTR TYPE OF INSURANCE WVD POLICY NUMBER MMfDolY MMIDDrrM <br /> x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 3 1.000,000 <br /> DAMAGE TO RENTE L)CLAIMS-MADE N OCCUR PREMISES Ea occurrence $ 500,000 <br /> MEO ExP(8my onePerson) $ 15.000 <br /> A X XCU is not excluded Y Y S2174309 08101/2019 08101l2020 PERSONAL&ADVINJURY $ 1,000,000 <br /> GEN'LAGCAEGATEUMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> POLICY [9 JPELaT LOC PRODUCTS-COMP*PAGG $ 2,000.000 <br /> S <br /> OTHER; <br /> AUTOMOBILE LIABILITY Ee a�da�SINGLE LIMIT S 1,000,000 <br /> ]sti ANYAUTO BODILY INJURY(Per Person) S <br /> A OWNED SCHEDULED S2174309 ORIO112019 08/01/2020 BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> x HIRED H <br /> NON-OWNED PROPERLY DAMAGE 3 <br /> AUTOS ONLY AUTOS ONLY Per ocidant <br /> UMBRELLA UAB x OCCUR EACH OCCURRENCE S 5,000,0()0 <br /> A "LESS LIAR CLAIMS-MADE- S2174341 08/01/2019 08/01/2020 AGGREGATE S 5,000,000 <br /> DEO I X1 RETENTION 5 0 $ <br /> WORKERS COMPENSATION STA7TJ EORT <br /> AND EMPLOYERS'LIABIUTY Y f N <br /> ANY PROPRIETORfPARTNEX5)(ECUTIVE E.L EACH ACCIDENT $ <br /> 1'000'000 <br /> B OFFICERIMEMBER EXCLUDED? 1 N f A WCV6147075 OSI0712019 08101/2020 <br /> (Mandatory in NH) E.LDISEASE-PAEMPIAYEE S 1,000,000 <br /> If yes,descdbe under 1,000,000 <br /> 147ip <br /> DIPTION OF OPERATIONS balow E.L SEASE-POLICY LIMITRented/Leased $125,000ment Floater 52174309 0810112019 0810112020 Equipment <br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(ACORO 1a1,Additional Remarks Schedule,may be attached If more space is requfred) <br /> The certificate holder Is included as additional insured with respects to general liability as required by written contract. The policies are written on a primary& <br /> non-contributory basis with a waiver of subrogation in favor of the certificate holder. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIE5 8E CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN <br /> Orange County Asset Management Services ACCORDANCE WITH THE POLICY PROVISIONS. <br /> PO Box 8181 <br /> AUTHORIZED REPRESENTATIVE �} <br /> Hlllsborough NC 27278 <br /> C 1908-2015 ACORD CORPORATION. Alf rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD <br />