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DocuSign Envelope ID:2D08E0A6-44C8-42A5-9E07-6E112B5FA32B <br /> DATE(MM/DDIYYYY) <br /> A�" CERTIFICATE OF LIABILITY INSURANCE <br /> 73/24/2021 <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 /> PRODUCER CONTACT <br /> NAME: Jeri Whitaker <br /> Marsh &McLennan Agency, LLC Company PHONE FAX <br /> 870 South Pleasantburg Drive A/C No Ext: A/C No):864-233-9291 <br /> Greenville SC 29606-5145 ADDRESS: certificates@marshmma.com <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURERA:Axis Surplus Insurance Company 26620 <br /> INSURED 9731 INSURER B: Phoenix Insurance Company 25623 <br /> Corporation <br /> 148 River Street, Suite 220 INSURER C:Travelers Casualtyand SuretyCompany19038 <br /> 148 Rive <br /> Greenville SC 29601 INSURERD: <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:478947127 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS <br /> LTR INSD WVD POLICY NUMBER MM/DDIYYYY MM/DDIYYYY <br /> A X COMMERCIAL GENERAL LIABILITY Y SP004434012020 12/1/2020 12/1/2021 EACH OCCURRENCE $1,000,000 <br /> CLAIMS-MADE OCCUR PREM SES�RENTE a o_cur ence $100,000 <br /> X 5,000 MED EXP(Any one person) $10,000 <br /> PERSONAL&ADV INJURY $1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 <br /> POLICY L] PRO LOC PRODUCTS-COMP/OP AGG $2,000,000 <br /> OTHER: $ <br /> B AUTOMOBILE LIABILITY Y 8105R210206 12/1/2020 12/1/2021 COMBINED SINGLE LIMIT $1,000,000 <br /> Ea accident <br /> X ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> L $ <br /> A X UMBRELLA LAB X OCCUR SX004435012020 12/1/2020 12/1/2021 EACH OCCURRENCE $4,000,000 <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000 <br /> DED RETENTION$ $ <br /> C WORKERS COMPENSATION UB5R235391 12/1/2020 12/1/2021 X PER OTH- <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER <br /> ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $1,000,000 <br /> OFFICER/MEMBER EXCLUDED? NIA <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 /> A Prof/Pollution Liability SP004434012020 12/1/2020 12/1/2021 Ea.Occ/Aggregate $1MM/$2MM <br /> Claims Made Ded.Per Wrongful Act $10,000 <br /> Retro Date:11-1-1993 Ded.per Poll.Cond. $10,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Additional Insured status applies to Pollution Liability and not to Professional Liability Coverage. <br /> Orange County North Carolina is included as Additional Insured under the General Liability and Automobile Liability with respect to work performed by the <br /> insured if required by written contract for the referenced job and/or contract. <br /> Umbrella is follow form underlying liability coverages evidenced on this certificate of insurance. <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 /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Orange County North Carolina <br /> 131 W. Margaret Lane, Suite 201 <br /> Hillsborough NC 27278 AUTHORIZED REPRESENTATIVE <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />