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DocuSign Envelope ID:3C542CCC-9BA3-4E25-8E23-7442510404E9 <br /> DATE(MM/DDIYYYY) <br /> A�" CERTIFICATE OF LIABILITY INSURANCE <br /> 73/16/2022 <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 <br /> NAME: Dana Gregory <br /> McGriff Insurance Services, Inc. PHONE FAX <br /> 2108 W. Laburnum Ave Suite 300 AIC No Ext: 804-678-5029 A/C No):888-751-3010 <br /> PO Box 17370 ADDRESS: certificatesvawv@mcgriffinsurance.com <br /> Richmond VA 23227 INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURERA:Continental Insurance Company 35289 <br /> INSURED 35TIMMOGRO INSURER B:XL Specialty Insurance Company 37885 <br /> Timmons Group Inc <br /> 1001 Boulders Parkway Suite 300 INSURERC:Valley Fore Insurance Company 20508 <br /> Richmond VA 23225 INSURER D: <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:1111382771 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/DDIYYYY MM/DDIYYYY <br /> A X COMMERCIAL GENERAL LIABILITY Y Y 6050247042 11/11/2021 11/11/2022 EACH OCCURRENCE $2,000,000 <br /> TED <br /> CLAIMS-MADE � OCCUR PREMISES(Ea o DAMAGE TO ccurrence) $1,000,000 <br /> MED EXP(Any one person) $15,000 <br /> PERSONAL&ADV INJURY $2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 <br /> POLICY jE LOC PRODUCTS-COMP/OP AGG $2,000,000 <br /> OTHER: $ <br /> C AUTOMOBILE LIABILITY Y Y BUA6050247039 11/11/2021 11/11/2022 COMBINEDSINGLELIMIT $1,000,000 <br /> Ea accident <br /> X ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED X NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> A X UMBRELLA LIAB X OCCUR Y Y 6050247056 11/11/2021 11/11/2022 EACH OCCURRENCE $10,000,000 <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 <br /> DED X RETENTION$In nnn $ <br /> c WORKERS COMPENSATION Y 6050025679 11/11/2021 11/11/2022 X PER OTH- <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE I I ER <br /> ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $1,000,000 <br /> OFFICER/MEMBER EXCLUDED? NIA <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 /> B *ProfessionalLiab. N Y DPR9968700 11/11/2021 11/11/2022 Per Claim $5,000,000 <br /> Aggregate $5,000,000 <br /> Deductible $250,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> *Umbrella coverage does not extend over Professional Liability <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 Planning and Inspections Department ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Attention: Christopher J. Sandt, PE <br /> 131 W Margaret Lane <br /> Suite 201 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 />