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DocuSign Envelope ID:C935184B-DO90-4E31-8070-B347099417FF <br /> 701/22/2020 <br /> E(MM/DD/YYYY) <br /> � CERTIFICATE OF LIABILITY INSURANCE <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 endorsement(s). <br /> PRODUCER CONTACT Darla Markel <br /> NAME: <br /> Deibler,Straub&Troutman PHONE FAX <br /> WC, <br /> IC No Ext: (A/C,No <br /> PO Box 828 ADDRESS: dmarkel@dstinsurance.com <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> Elizabethville PA 17023 INSURER A: Travelers Insurance Company 25682 <br /> INSURED INSURER B: Carolina Mutual Insurance <br /> Swab Wagon Company, Inc. INSURERC: <br /> P.O.Box 919 INSURER D: <br /> INSURER E: <br /> Elizabethville PA 17023 INSURERF: <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 INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS <br /> LTR IN SD WVD POLICY NUMBER MM/DD/YYYY MM/DD <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> CLAIMS-MADE � OCCUR -PREMISES <br /> (Ea occur DAMAGE TO ence) $ 300,000 <br /> MED EXP(Any one person) $ 10,000 <br /> A 1A410172 7/12/2019 7/12/2020 PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> POLICY PRO JECT ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 <br /> Ea accident <br /> X ANY AUTO BODILY INJURY(Per person) $ <br /> A OWNED SCHEDULED BA2N5505171914G 07/12/2019 07/12/2020 BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> X HIRED �/ NON-OWNED PROPERTY DAMAGE <br /> AUTOS ONLY X $AUTOS ONLY Per accident <br /> X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 <br /> A EXCESSSLLIAB CLAIMS-MADE CUP81\1513963 7/12/2019 7/12/2020 AGGREGATE $ 1,000,000 <br /> DED X RETENTION$ $ <br /> WORKERS COMPENSATION X STATUTE ER <br /> H <br /> AND EMPLOYERS'LIABILITY <br /> B OFFICER/MEMBER EXC UDED?ECUTIVE Y❑ N/A WC23031-2019 7/12/2019 7/12/2020 E.L.EACH ACCIDENT $ 500,000 <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 <br /> If yes,describe under 500,000 <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 /> Orange County ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 200 S.Cameron Street <br /> AUTHORIZED REPRESENTATIVE <br /> PO Box 8181 <br /> Hillsborough NC 27278 <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />