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DocuSign Envelope ID:OC78lF21-7ADF-4F63-8BA1-4FA046EA6BO2 <br /> DATE(MM/DD/YYYY) <br /> ,acoRo° CERTIFICATE OF LIABILITY INSURANCE <br /> 12/1i2022 12/8/2021 <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 Lockton Insurance Brokers,LLC CONTACT <br /> NAME: <br /> 777 S.Figueroa Street,52nd Fl. PHONE FAX <br /> CA License#OF 15767 E-MAILo Ext: A/C No <br /> Los Angeles CA 90017 ADDRESS: <br /> (213)689-0065 INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURERA:Valley Forge Insurance Company Compamny 20508 <br /> INSURED MCCi LLC INSURER B:American Casualty Company of Reading,PA 20427 <br /> 1456427 3717 Apalachee Parkway INSURER C:The Continental Insurance Company 35289 <br /> Tallahassee FL 32311 INSURER D:Mount Vernon Specialty Insurance Company 14420 <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES MCCILOI CERTIFICATE NUMBER: 16179208 REVISION NUMBER: XXXXXXX <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 POLICY NUMBER MM/DDIYYYY MM/DDIYYYY <br /> A X COMMERCIAL GENERAL LIABILITY y N 6072067360 12/1/2021 12/1/2022 EACH OCCURRENCE $ 1,000,000 <br /> A AGE To <br /> CLAIMS-MADE �OCCUR PREENTE <br /> M SES Ea occu ence $ 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: GENERAL AGGREGATE $ 2,000,000 <br /> X POLICY JE� LOC PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> OTHER: $ <br /> B AUTOMOBILE LIABILITY N N 6072067343 12/1/2021 12/1/2022 (CO zBINE <br /> NeDtSINGLE LIMIT $ 1,000,000 <br /> ANY AUTO BODILY INJURY(Per person) $ XXXXXXX <br /> X OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS XXXXXXX <br /> HIRED X NON-OWNED PROPERTY DAMAGE $ XXX�CS�XX <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> X Comp.Ded.$ 00 Coll.Ded. $ 1,000 <br /> C X UMBRELLA LIAB X OCCUR N N 6072067357 12/1/2021 12/1/2022 EACH OCCURRENCE $ 5,000,000 <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 <br /> DED X RETENTION$ 10,000 $ XXXXXXX <br /> WORKERS COMPENSATION PER OTH- <br /> C AND EMPLOYERS'LIABILITY N 6072067326 ASS) 12/1/2021 12/1/2022 X STATUTE ER <br /> C ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 6079501170(CA) 12/1/2021 12/1/2022 E.L.EACH ACCIDENT $ 1,000,000 <br /> OFFICER/MEMBER EXCLUDED? FNI N/A <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 Tech E&O/Cyber Liability N N DPS4002374 12/1/2021 12/1/2022 Limit:$5,000,000 <br /> SIR:$100,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Certificate Holder is an Additional Insured to the extent provided by the policy language or endorsement issued or approved by the insurance carrier. <br /> CERTIFICATE HOLDER CANCELLATION See Attachment <br /> 16179208 <br /> Orange County,NC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> 200 South Cameron Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Hillsborough NC 27278 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPR <br /> 7 <br /> ©1 88-201 AC D CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />