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DocuSign Envelope ID:7845CF89-4637-4165-BA3D-1880C2F6FO20 <br /> DATE(MM/DD/YYYY) <br /> A�" CERTIFICATE OF LIABILITY INSURANCE <br /> 12/31/2019 <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 Sherry Whaley,AAI,CRIS <br /> NAME: <br /> Jake A Parrott Insurance Agency Inc aCC Ext: (252)523-1041 AIX No): (252)523-0145 <br /> 2508 N HERRITAGE STREET E-MAIL swhaley@parrottins.com <br /> ADDRESS: <br /> PO BOX 3547 INSURER(S)AFFORDING COVERAGE NAIC# <br /> KINSTON NC 28502 INSURERA: EMPLOYERS MUTUAL CASUALTY CO 21415 <br /> INSURED INSURER B: ACCIDENT FUND INSURANCE CO OF AMERICA 10166 <br /> TRI SOLUTIONS INC DBATILE RESTORATION INSURERC: <br /> 712 SUMMITAVE INSURER D: <br /> INSURER E: <br /> KINSTON NC 28501-3134 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: MASTER 20 21 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 INSURANCEADDLSUBR POLICY EFF POLICY EXP <br /> LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> CLAIMS-MADE X OCCUR PREM SES Ea oNcE ante $ 500,000 <br /> MED EXP(Any one person) $ 10,000 <br /> A Y 5D86997 01/01/2020 01/01/2021 PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> X JECT LOC PRODUCTS-COMP/OPAGG $POLICY PRO 2,000,000 <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 <br /> Ea accident <br /> X ANYAUTO BODILY INJURY(Per person) $ <br /> A OWNED SCHEDULED Y 5E86997 01/01/2020 01/01/2021 BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accidHent <br /> Medical payments $ 5,000 <br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 <br /> A EXCESS LAB CLAIMS-MADE 5J86997 01/01/2020 01/01/2021 AGGREGATE $ 2,000,000 <br /> DED I I RETENTION $ $ <br /> WORKERS COMPENSATION X1 STATUTE ERER H <br /> AND EMPLOYERS'LIABILITY Y/N 1,000,000 <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ <br /> B OFFICER/MEMBEREXCLUDED? NIA WCV6152738 01/01/2020 01/01/2021 <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 <br /> If yes,describe under 1,000,000 <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> INLAND MARINE/INSTALLATION CATASTROPHE-JOB LT $57,000. <br /> A FLOATER 5C86997 01/01/2020 01/01/2021 DEDUCTIBLE $ 500. <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> ORANGE COUNTY IS LISTED AS AN ADDITIONAL INSURED AS PERTAINS TO GENERAL LIABILITY,ON A PRIMARY&NON-CONTRIBUTORY <br /> BASIS,INCLUDING PRODUCTS&COMPLETED OPERATIONS,VIAA WRITTEN CONTRACT IN PLACE WITH THIS REQUIREMENT INCLUDED. <br /> ORANGE COUNTY IS LISTED AS AN ADDITIONAL INSURED AS PERTAINS TO AUTO LIABILITY,VIAA WRITTEN CONTRACT IN PLACE WITH THIS <br /> REQUIREMENT INCLUDED.WAIVER OF SUBROGATION IN FAVOR OF ADDITIONAL INSURED APPLIES TO GENERAL AND AUTO LIABILITY AND <br /> WORKER'S COMPENSATION,VIAA WRITTEN CONTRACT IN PLACE WITH THIS REQUIREMENT INCLUDED. EXCLUDED OFFICERS IN WORKER'S <br /> COMPENSATION COVERAGE:DAVID ALBRITTON&CHARLES ALBRITTON III. <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 /> PO BOX 8181 <br /> AUTHORIZED REPRESENTATIVE <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 />