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DocuSign Envelope ID: FA8009F9-A6EA-462D-967D-8806AO26773B
<br /> RACAN-1 OP ID: CB
<br /> CERTIFICATE OF LIABILITY INSURANCE DATEIMMIDDNYYY1
<br /> �� 0212112020
<br /> THIS CERTIFICATE 1S 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(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 endorsements.
<br /> PRODUCER
<br /> 631-424-3300 CT Colleen Bresnahan
<br /> Robert C.Bill Associates,Inc PHONE 631-424-3300 FAX 831-427.0105
<br /> 150 Broadhollow Road Suite 307 AIC,No,Ext: IA;C No
<br /> Melville,NY 11747 rosna an ro eftbillassoClatoS.001711
<br /> Robert Bill
<br /> INSURERS AFFORDING COVERAGE NAIL#
<br /> _ INSURaRA:Starr Indemnity,&Liability Co 38318
<br /> AMNn INSURER 14,Great American Insurance
<br /> elll Construction South, $Irius International Insurance
<br /> Me.t INSURER c
<br /> Suie 9e0berton Hill Road INSURER❑ Zurich American Insurance Co. 27855
<br /> Apex,NC 27502.4265 Navigators Insurance Com an 42307
<br /> INSURER E: g p y
<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 /> INSR LTR TYPE OF INSURANCE DDL BURR POLICY NUMBER POLICY EFFMMIDDIYYYYI POLICY EXP LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000
<br /> PREMISr
<br /> CLAIh4$-MADE X OCCUR x X1000025778201 D113112020 0113112021 DAMAGE TO Rz.ENTED occurrencel 5 300,000
<br /> MED EXP(Any one arson S 10,000
<br /> x xCu 2,000,a00
<br /> PER L&ADV INJURY 5
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE 5 4,000,000
<br /> POLICY E91 veT LOC PRODUCTS-COMFiOP AGG 5 4,000,000
<br /> OTHER: Emp.Ben. 5 1,000,000
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 5
<br /> ANY AUTO BODILY INJURY Perperson) S
<br /> OWNEAUTOS ONLY SCHEDULED
<br /> SSWUtNEEDp SOD ILY�ITNJURY Per accident S
<br /> All &ONLY Al M ONLY PB�acEcfdsnt AMAGE $
<br /> S
<br /> A UMBRELLA LIAR x OCCUR I EACH OCCURRENCE S 3,000,000
<br /> X EXCESS LIAB CLAIMS-MADE x x 1000596171201 01/31/2020 01131/2021 AGGREGATE S 3,000,000
<br /> DE❑ I I RETENTIONS I I5
<br /> A WORKERS COMPENSATION x PER 1 OTH-
<br /> AND EMPLOYERS'LIABILITY
<br /> ANY PROPRIETORlPARTNER/EXECUTIVE YIN x 100 0004051 0113112020 01131/2021 E.L.EACH ACCIDENT 1,000,000
<br /> RFFICER/M EM BE R EXCLUD507 ] NIA
<br /> andatoryInN } E.L.DISEASE-EA EMPLOYE 1,000,000
<br /> If es,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> C Pollution1professi x x CPPL*0001628-0 01131/2020 01/31/2021 Occ/Agg 5,000,000
<br /> B Property }( X IMPE16478604 12131/2019 12/3112020 Limit 8883933
<br /> DESCRIPTION OF OPERATIONS!LOCATIONS 1 VEHICLES IACORD 101,Additional Remarks Schedule,may be attached if more space is required]
<br /> Orange County is Included as additional insured if reqqulred by written
<br /> contract per endorsement form#CG2010 04 13&CG2D37 04 13 to the
<br /> extent provided therein,subject to policy terms limitations and exclusions.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> ORANGEC
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> g ty ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> PO Box 8181
<br /> Hillsborough,NC 27278
<br /> AUTHORIZED REPRESENTATIVE
<br /> 4'�7'2—
<br /> ACORD 25(2016/03) ©1988-2016 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and Ingo are registered marks of ACORD
<br />
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