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DocuSign Envelope ID: EOC82D46-2F84-44EB-8OF9-4B562DB4309E <br /> ACCO" CERTIFICATE OF LIABILITY INSURANCE 12i31/2019 ) <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 Charter Risk Management <br /> NAME: g <br /> Marsh USA, INC. PHONE FAX <br /> 701 Market Street, Suite 1100 A/C No Ext: A/C No: <br /> St. Louis, MO 63101 E-MAIL certificaterequests@charter.com <br /> ADDRESS: <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> COMPANY A: National Union Fire Ins Co Pittsburgh PA 19445 <br /> INSURED COMPANY B: Commerce and Industry Insurance Company 19410 <br /> Charter Communications, Inc. COMPANY C: Ace Property & Casualty Insurance Company 20699 <br /> 400 Atlantic Street <br /> Stamford, CT 06901 COMPANY D: AIU Insurance Company 19399 <br /> COMPANY E: New Hampshire Insurance Company 23 84 1 <br /> COMPANY F: American Home Assurance Company 19380 <br /> COVERAGES CERTIFICATE NUMBER: 310163 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/DD/YYYY MM/DDIYYYY <br /> B X COMMERCIAL GENERAL LIABILITY GL 3629906 1/1/2020 1/1/2021 $1,000,000 <br /> EACH OCCURRENCE $ <br /> CLAIMS-MADE n OCCUR PREMISES <br /> ('a <br /> a oDAMAGE TO Ncur ence) $ $500,000 <br /> MED EXP(Any one person) $ $10,000 <br /> PERSONAL&ADV INJURY $ $1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ $3,000,000 <br /> X <br /> POLICY❑ PRO- ❑ LOC PRODUCTS-COMP/OPAGG $ $1,000,000 <br /> JECT <br /> OTHER: $ <br /> A AUTOMOBILE LIABILITY CA 1921838 (AOS) 1/1/2020 1/1/2021 COMBINED SINGLE LIMIT $ $1,000,000 <br /> A X CA 1921839 (MA) 1/1/2020 1/1/2021 Ea accident <br /> p ANY AUTO CA 1921840 (VA) 1/1/2020 1/1/2021 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 /> C X UMBRELLALIAB X G28119616 005 1/1/2020 1/1/2021 1,000,000 <br /> OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION See second page for 1/1/2020 1/1/2021 X PER OTH- <br /> AND EMPLOYERS'LIABILITY Y/N specific policy 1/1/2020 1/1/2021 STATUTE ER <br /> ANYPROPRIETOR/PARTNER/EXECUTIVE information. 1/1/2020 1/1/2021 E.L.EACH ACCIDENT $ $5,000,000 <br /> OFFICER/MEMBER EXCLUDED? N/A 1/1/2020 1/1/2021 <br /> (Mandatory $5,000,000 <br /> ( ry'in NH) 1/1/zozo 1/1/zozl E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under 1/1/2020 1/1/2021 $5,000,000 <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> A Excess WC OH ($5M Retention) XWC 4595566 (QSI OH) 1/1/2020 1/1/2021 Employers Liability $5,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Please see page 2 for additional insureds and any additional language. <br /> CERTIFICATE HOLDER CANCELLATION <br /> Orange County NC <br /> 131 W Margaret Lane SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> PO BOX 8181 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Hillsborough, NC 27278 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> Joseph M. Lee <br /> ©1988-2016 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />