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DocuSign Envelope ID:565001 EC-448E-411 F-84E4-E84E407F6249
<br /> I DIXON-2 OP ID: KS
<br /> ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
<br /> F61,28/2021
<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 endorsements .
<br /> PRODUCER 828-648-2632 CONTACT Patton, Morgan&Clark
<br /> NAME,Patton, Morgan&Clark PHONE 828-648-2632 FAX 828-648-2642
<br /> P O Box 1027 (A/C,No,Ext): (A/C,No):
<br /> Canton,NC 28716 E-MAIL
<br /> Patton, Morgan&Clark ADDRESS:
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURER A:The Travelers Companies Inc, 25682
<br /> INSURED INSURER B:
<br /> Dixon Hughes Goodman LLP
<br /> DBA Dixon Hughes Goodman LLP 700 INSURER C:
<br /> P.O.Box 3049
<br /> Asheville,NC 28802 INSURER D:
<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 /> INSR TYPE OF INSURANCE DDL SUBR POLICY NUMBER POLICY YFF POLICY EXP yyy) LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE � OCCUR 630-5E183024-COF-21 06/01/2021 06/01/2022 DAMAGE TO RENTED 1,000,000
<br /> PREMISES Ea occurrence $
<br /> MED EXP(Any oneperson) $ 10,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> X POLICYEl PECOT- LOC PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> OTHER:
<br /> A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
<br /> Ea accident $
<br /> ANY AUTO BA-1N048382-21-43-G 06/01/2021 06/01/2022 BODILY INJURY Perperson) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY Per accident $
<br /> X HIRED X NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY Per accident $
<br /> A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 15,000,000
<br /> EXCESS LIAB CLAIMS-MADE CUP-1J921907-21-43 06/01/2021 06/01/2022 AGGREGATE $ 15,000,000
<br /> DED X RETENTION$ 10000
<br /> A WORKERS COMPENSATION X PER OTH-
<br /> AND EMPLOYERS'LIABILITY STATUTE ER
<br /> Y/N UB-61<186824-21-43-G 06/01/2021 06/01/2022 1,000,000
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $
<br /> OFFICER/MEMBER EXCLUDED? N/A
<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 /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Orange Count Health Dept. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> g Y P ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> PO Box 8181
<br /> Hillsborough, NC 27278
<br /> AUTHORIZED REPRESENTATIVE
<br /> Patton, Morgan&Clark dv
<br /> I rNit W;��
<br /> ACORD 25(2016/03) ©1988-2015 ACORD dORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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