2021-010-E AMS-Walker Auto Supply 2021 parts contract

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DocuSign Envelope ID:3C82534E-AFB3-4C21-8943-F082904898FD DATE(MM/DD/YYYY) A�o® CERTIFICATE OF LIABILIT I SURANCE 12/22/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND O FE S NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEN OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A C1 NTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(h s mu t be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsen a t. statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTAC NAME: Whi Howard BATCHELOR&ASSOCIATES,LLC PHONE 9 9-694-1300 aC No): 919-301-8849 3200 WAKE FOREST RD E-MAIL WH T BATCHELORANDASSOCIATES.COM ADDRES : SUITE 200 1 1 INSURERS AFFORDING COVERAGE NAIC# RALEIGH NC 27609 INSURER : ER E INSURANCE EXCHANGE 26271 INSURED INSURER B: FI ST BENEFITS 16233 WAS VENTURES LLC INSURER WALKER AUTOMOTIVE SUPPLY INC INSURER 705 E SIX FORKS RD INSURER RALEIGH NC 27609-7831 INSURER COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN IS 3UED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY C NTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY T11 E POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN RE L CEE BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR O CY FF POLICY EXP LIMBS LTR POLICYNUMBER D MM/DD X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE FX—I OCCUR PREMISES Ea occurrence) $ 2,000,000 MED EXP(Any one person) $ 5,000 A Q97-0882923 C 1/ 1/2 21 01/01/2022 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY❑ PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 4,000,000 JECT X OTHER: Blanket Building Cov $ 19,408,900 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ A X ALL OWNED SCHEDULED Q01-0141648 0 / 1/2 21 01/01/2022 BODILY INJURY(Per accident) $ /� AUTOS AUTOS S NON-OWNED PROPERTY DAMAGE $ 1,000,O00 X HIREDAUTOS AUTOS Per accident Deductible $ 1000 Comp/coll X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 7,000,000 A EXCESS LIAB CLAIMS-MADE Q25-0174889 0 / 1/2 21 01/01/2022 AGGREGATE $ 71000,000 DED I X I RETENTION$ 0 $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN N X STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 B OFFICER/MEMBEREXCLUDED? ❑N NIA 8365 0 / 1/2 21 01/01/2022 500,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be at ac ed if more space is required) Orange County,its officers,agents,and employees are listed as additional insured under je era liability per the terms of the written contract Location:Orange County IBS(NAOA#589)600 Highway 86 N Hillsborough NC 27278 CERTIFICATE HOLDER CANCE TI N SHOUL NY F THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE RA ION DATE THEREOF, NOTICE WILL BE DELIVERED IN Orange County ACCO INC WITH THE POLICY PROVISIONS. 600 Highway 86 N AuT,4bRtzI IEPR SENTATIVE Hillsborough NC 27278 0 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are regis el m rks of ACORD