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DocuSign Envelope ID:6CF06457-7118-4304-9934-67C64310797A <br /> ® DATE(MM/DD/YYYY) <br /> A�o CERTIFICATE OF LIABILITY INSURANCEF2/19/2021 <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 /> ;CIPRODUCER NAME:CT Jay Brillheart <br /> McGriff Insurance Services PHONE FAX <br /> 2108 W. Laburnum Ave Suite 300 e •540-808-1222 a/c No):888-751-3010 <br /> PO Box 17370 ADDRESS: certificatesvawv@mcgriffinsurance.com <br /> Richmond VA 23227 INSURERS AFFORDING COVERAGE NAICft <br /> INSURERA:Valley Fore Insurance Company 20508 <br /> INSURED 35SMEINC INSURERB:Travelers Property Casualty Co of Amer 25674 <br /> S&ME Inc. <br /> 3201 Spring Forest Road INsuRERc:American Casualty Co of Reading PA 20427 <br /> Raleigh, NC 27616 INSURERD:XL Specialty Insurance Company 37885 <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:103063680 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 I ADDLTYPE OF INSURANCE INSD WVQ SUER POLICY NUMBER MMIDDIYYYY MM EFF LDDY� LIMITS <br /> LTR <br /> A X COMMERCIAL GENERAL LIABILITY Y Y 6042844344 7/1/2020 7/1/2021 EACH OCCURRENCE $1,000,000 <br /> F_y_1 IMAGE RENTED <br /> CLAIMS-MADE OCCUR PREM SESOEa occurrence) <br /> ccuence $1,000,000 <br /> MED EXP(Any one person) $15,000 <br /> PERSONAL&ADV INJURY $1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $2,000,000 <br /> POLICY[X]JECT � LOC PRODUCTS-COMP/OPAGG $2,000,000 <br /> OTHER: $ <br /> A AUTOMOBILE LIABILITY Y Y BUA6042844313 7/1/2020 7/1/2021 COMBINED SINGLE LIMIT $2,000,000 <br /> Ea accident <br /> X ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> X HIRED IX <br /> NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> B X UMBRELLA LIAB X OCCUR Y Y ZUP51M6239520NF 7/1/2020 7/1/2021 EACH OCCURRENCE $5,000,000 <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 <br /> DED I X I RETENTION$ PER OTH- $ <br /> C WORKERS COMPENSATION Y WC678651782 7/1/2020 7/1/2021 X <br /> AND EMPLOYERS'LIABILITY STATUTE ER <br /> ANYPROPRIETOR/PARTNER/EXECUTIVE N] N/A E.L.EACHACCIDENT $1,000,000 <br /> OFFICER/MEMBER EXCLUDED? <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000.000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 <br /> D Professional Liability DPR9962088 7/1/2020 7/1/2021 5.000,000 Per Claim <br /> including Pollution 5,000,000 Aggregate <br /> DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) <br /> Umbrella policy extends over General Liability,Automobile Liability and Employers'Liability coverages. <br /> In the event that the Company cancels the General Liability,Automobile Liability or Employers'Liability policies for any statutorily permitted reason other than <br /> non-payment of premium,the Company agrees to provide ninety(90)days notice of cancellation of the Policy to any entity with Whom the NAMED INSURED <br /> agreed in a written contract or agreement would be provided with notice of cancellation of the policy. <br /> In the event that the Company cancels the Professional Liability policy for any statutorily permitted reason other than non-payment of premium,the Company <br /> agrees to provide thirty(30)days notice of cancellation of the Policy to any entity with Whom the NAMED INSURED agreed in a written contract or agreement <br /> See Attached... <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 /> Department of Environment,Agriculture, Parks and <br /> Recreation AUTHORIZED REPRESENTATIVE <br /> 306 Revere Road <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 />