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DocuSign Envelope ID: F986BAOD-F2E5-436E-A80D-D4FBF4513631
<br /> FIRSFIR-01 TEARLY
<br /> ,4coR0` CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
<br /> 1/26/2022
<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 Ty Early
<br /> Pittman Insurance Group,LLC PHONE FAX
<br /> 4011 Westchase Blvd.Suite 120 (A/C,No,Ext): (919)518-9480 (A/C,No):
<br /> Raleigh,NC 27607 ADDRESS:ty@pittgroupllc.com
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURER A:Philadelphia Indemnity Insurance Co. 18058
<br /> INSURED INSURER B:Accident Fund Insurance Co of 10166
<br /> First Fire Protection of INC Inc. INSURER C:
<br /> PO Box 10594 INSURER D:
<br /> Raleigh,NC 27605
<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 ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD MM DD YYY MM DD YYY
<br /> A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X OCCUR PHPK2351059 11/14/2021 11/14/2022 DAMAGE TO RENTED 300,000
<br /> X X PREMISES Ea occurrence $
<br /> MED EXP(Any oneperson) $ 5,000
<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: $ Included
<br /> A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
<br /> Ea accident $
<br /> X ANY AUTO X X PHPK2351059 11/14/2021 11/14/2022 BODILY INJURY Perperson) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY Per accident $
<br /> HIRED L $
<br /> NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY Per accident $
<br /> A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000
<br /> EXCESS LIAB CLAIMS-MADE PHUB793713 11/14/2021 11/14/2022 AGGREGATE $ 2,000,000
<br /> DED RETENTION$ $
<br /> B WORKERS COMPENSATION X PER OTH-
<br /> ANDEMPLOYERS'LIABILITY STATUTE ER
<br /> WCV6226004 11/14/2021 11/14/2022 1,000,000
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE N/A X E.L.EACH ACCIDENT $
<br /> OFFICER/MEMBER EXCLUDED?
<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 /> Orange County,INC is included as additional insured with regards to General Liability and Auto Liability(performs perform PI-SG-016,PI-GLD-SG).A waiver
<br /> of Subrogation applies in favor of Orange County,NC with repsect to General Liability,Auto Liability and Workers Compensation.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Orange Count NC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> 9 y, ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> PO Box 8181
<br /> Hillsborough,INC 27278
<br /> AUTHORIZED REPRESENTATIVE
<br /> �U
<br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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