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DocuSign Envelope ID:7BCE8ED6-7B33-485B-9DED-EFB2EC7A5394
<br /> SIMM&SI-01 LSCOTTO
<br /> Al �J►R CERTIFICATE OF LIABILITY INSURANCE OATS/23/20Y
<br /> 1123/200
<br /> 20
<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 Lisa R.Scotto
<br /> NAME: _
<br /> Trisure,an Alera Group Company PHONE FAX
<br /> 4325 Lake Boone Trail,Suite 200 (AIC,No,Exl):(919)469-2473 (AIC,No):(919)4674987
<br /> EMAIL (SCOttO trisure.com
<br /> Raleigh,NC 27607 ;.ADDRESS: — __
<br /> INSURER(S)AFFORDING COVERAGE. _ NAIC N
<br /> INSURER A:Selective Insurance Co.of America_. ,12572
<br /> INSURED ,INSURER B;Accident Fund Insurance Comp
<br /> any of America 110166 _.
<br /> Simmons&Simmons Management,Inc. INSURER C:The,Hanover_Insurance Company 22292
<br /> P 0 Box 1460 I INSURER D: _
<br /> Clinton,NC 28329
<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 /> — _ 1 _
<br /> INSR ADDL SUBRi I POLICY EFF POLICY EXP LIMITS
<br /> LT TYPE OF INSURANCE , D p, POLICY NUMBER D MIDD Y
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE I X OCCUR IS 1622065 : 6/3/2020 6/3/2021 DAMAGE TO RENTED 1500,000
<br /> PREMISES(Ea occurrence) 5 _
<br /> !.MED EXP(Any one person) ,$ __.. 15,000
<br /> PERSONAL&ADV INJURY S 1,000,000
<br /> GENT.AGGREGATE LIMIT APPLIES PER: 1 GENERAL AGGREGATE_ 1$ _ 3,000,000
<br /> POLICY, X PRO- 1 JECT LOC j PRODUCTS-COMPIOPAGG 5 3'000'OQQ
<br /> OTHER: S
<br /> A � COMBINED SINGLE LIMIT 1,000,000
<br /> I AUTOMOBILE LIABILITY ,lEa accWenU..__
<br /> X ANY AUTO iS 1622065 6/3/2020 6/3/2021 BODILY INJURY(Per person) S
<br /> OWNED SCHEDULED j
<br /> AUTOS ONLY AUTOS BODILY INJURY(Per accident)
<br /> HIRED NON-OWNED ! PROPERTY AMAGE
<br /> I AUTOS ONLY AUTOS ONLY L I,, , Per accidentg $... _
<br /> $
<br /> 00
<br /> A X UMBRELLAUAB X OCCUR EACH OCCURRENCE___ $ 1--- - - -
<br /> EXCESSLIAB CLAIMS•MADE! t
<br /> S 1622065 6/3/2020 6l3/2021 1,000,000
<br /> AGGREGATE S ..
<br /> i
<br /> DED -:.. X RETENTIONS 0' (5
<br /> B WORKERS COMPENSATION X.I STATUTE J ERH
<br /> AND EMPLOYERS'LIABILITY
<br /> YIN WCV6008339 6/3/2020 61312021 1-,000,000
<br /> ANY PROPRIETORIPARTNERfEXECUTNE 1/ N 1 A � Ea EACH ACCIDENT
<br /> OFFICERIME MBEft EXCLUDED? 1,000,QQQ
<br /> (Mandatory in NNH) E.L DISEASE-EA EMPLOYEE,$ _
<br /> 'i Ir yes,describe u ,nder
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 000,QQQ
<br /> C !Rented/Leased Equip. IIH69585858 6/3/2020 1 6/3/2021 Limit 500,000
<br /> I I
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached It more space is required)
<br /> Workers Compensation Excluded Officer:David Simmons
<br /> County of Orange is an additional insured as respects General Liability when required by written contract.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF,County of Orange ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> TCE WILL BE DELIVERED IN
<br /> Solid Waste&Recycling
<br /> PO Box 17177
<br /> Chapel Hill,NC 27516 AUTHORIZED REPRESENTATIVE
<br /> Udic&b
<br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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