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DocuSign Envelope ID:68C29904-7173-4D2E-A7C2-793850AFB68F SHERY-1 OP ID: MA <br /> —1 <br /> �CpRo CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) <br /> 0 311 7/2 0 2 0 <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 endorsements . <br /> PRODUCER 919-932-9990 CONTACT Martin Hall <br /> Lee-Moore Insurance Agency Inc NAME: <br /> P.O. Box 667 g y (A/C,No,Ext):919-932-9990 (AIC No):AX 919-933-0155 <br /> West End, NC 27376 E-MAIL eemoore.martm gmal .com <br /> Alex Maiolo ADDRESS: <br /> INSURERS AFFORDING COVERAGE NAIC# <br /> INSURERA:AUTO-OWNERS INS.COMPANY 18988 <br /> INSURED INSURER B: <br /> Sheryl Raulli Mead <br /> DBA Shaerie Mead INSURER C: <br /> 437 Dimmocks Mill Rd-#27-1 <br /> Hillsborough,INC 27278 INSURERD: <br /> 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 /> INSR LTR TYPE OF INSURANCE DDL UBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> CLAIMS-MADE OCCUR 35760451 03/16/2020 03/16/2021 DAMAGE ( RENTED 50,000 <br /> X PREMISES Ea occurrence $ <br /> MED EXP(Any oneperson) $ 5,000 <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000 <br /> POLICY JECOT- LOC PRODUCTS-COMP/OP AGG $ 1,000,000 <br /> 17 OTHER: <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> Ea accident $ <br /> ANY AUTO BODILY INJURY Perperson) $ <br /> OWNED SCHEDULED <br /> AUTOS ONLY AUTOS BODILY INJURY Per accident $ <br /> HIRED NON-OWNED PerOPERTntDAMAGE $ <br /> AUTOS ONLY AUTOS ONLY <br /> L F $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <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 /> Orange County NC is listed as additional insured for General Liability,as <br /> their Interests may appear. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Orange Count NC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> g Y ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 300 W Tryon St <br /> Hillsborough, NC 272728 <br /> AUTHORIZED REPRESENTATIVE <br /> Alex Maiolo <br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />