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DocuSign Envelope ID: D532D6C8-D6FD-42D6-9F88-CF4FDECD6C1F <br /> AC FDAre{M/2020 rYl <br /> CERTIFICATE OF LIABILITY INSURANCE 213r2a2Q <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY ANQ CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, TH <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIE <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZE <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject t <br /> the terms and conditions of the policy,certain policies may require an endorsement- A statement on this certificate does not confer rights to th <br /> certificate holder In lieu of such endorsement(s). <br /> PRODUCER CON7AC1 <br /> VGM Insurance Services,Inc. NAME, <br /> 1111 W.San Maman Dr. PHONE Fax <br /> AIG NaIt <br /> E-MAIL <br /> Waterloo IA 50701 Sg' <br /> INSURER(S)AFFORDING COVERAGE NAIC r <br /> INSURERA: BENCHMARK INSURANCE COMPANY 41394 <br /> INSURED AMA.1S Group Inc. INSURERS: GREAT NORTHERN INSURANCE:COMPAI 20702 <br /> 101 Mobility NC Triangle Metro Area INSURER C: CHUBB INDEMNITY INSURANCE COMPAI <br /> 3209 Gresham Lake Rd,Ste 106 INSURER D: <br /> Raleigh NC 27615 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 /> IPLISR <br /> TYPE OF INSURANCE SWWI R POLICY NUMBER MMIDD EFF PMLOICOY EXP <br /> YYY LIMITS <br /> A x COMMERCIAL GENERAL LIABILITY x ❑1018 G5889-2 08/20/2019 0812OM20 EACH OCCURRENCE $ 2.000,000 <br /> CLAIM34AADF FT OCCUR PTA REMISES Ea ocogmnW Ti5MNTED S 1QQ,000 <br /> X Professional Liabill!y MEDEXP one person) a 5,000 <br /> PERSONAL&ADV INJURY $ 2,000,000 <br /> GEN'L AGGREGATE U:drr APPLIES PER: GENERAL AGGREGATE S 4,000.000 <br /> 7C POUCY[7]JET ❑LOC PROM CTS-COMPIOPAGG S 4r000,000 <br /> OTHER; $ <br /> B AUTOMOBILE LIABILITY 73604951 08120r2019 0812012020 DaMa;i e t GLE uMlr y 1,000,000 <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY[Per accident] $ <br /> AUTOSAUT NOI,LOWNED PROPERTY DAMAG S <br /> HIRED AUTOS AUTOS a <br /> 5 <br /> 4U=LALAB OCCUR EACH OCCURRENCE 8 <br /> ELIAR CAMS-MADE AGGREGATE $ <br /> DED RETENTIONS ER TR 8 <br /> WORKERS COMPENSATION 7177-50-35 02I(2020 MI2027 P p <br /> AND EMPLOYERS'LIABILITY YIN <br /> ANY PROPRIETORIPARTNERtEXECUTIVE NIA E.L EACH ACCIDENT $ 11000,000 <br /> OFFICEWM(Mandatory In H)EXCLUDED? EL DISEASE-EA EUMPLOY S 1,000,000 <br /> (Mandatory In NH} <br /> Wearlibe under OQQ,DOD <br /> DESCRIPTION OF OPERATIONS below F-L DISEASE-POLICY UMIT S 1, <br /> DESCRIPTION OF OPERATIONS I LOCATIONS t VEHICLES(ACORD IIII,Addition.{Remarks Se hedu to,may ea attached If more space Is re qulmd) <br /> Certificate holder Is listed as an Additional Insured. <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 /> PO Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Hillsborough NC 27278 <br /> AUTHORIZED REPRESENTATIVE <br /> C 1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014101) The ACORD name and logo are registered marks Of ACORD <br />