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SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />INSURER(S) AFFORDING COVERAGE <br />INSURER F : <br />INSURER E : <br />INSURER D : <br />INSURER C : <br />INSURER B : <br />INSURER A : <br />NAIC # <br />NAME: <br />CONTACT <br />(A/C, No): <br />FAX <br />E-MAIL <br />ADDRESS: <br />PRODUCER <br />(A/C, No, Ext): <br />PHONE <br />INSURED <br />REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES <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 />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 />OTHER: <br />(Per accident) <br />(Ea accident) <br />$ <br />$ <br />N / A <br />SUBR <br />WVD <br />ADDL <br />INSD <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 />$ <br />$ <br />$ <br />$PROPERTY DAMAGE <br />BODILY INJURY (Per accident) <br />BODILY INJURY (Per person) <br />COMBINED SINGLE LIMIT <br />AUTOS ONLY <br />AUTOSAUTOS ONLY <br />NON-OWNED <br />SCHEDULEDOWNED <br />ANY AUTO <br />AUTOMOBILE LIABILITY <br />Y / N <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH) <br />DESCRIPTION OF OPERATIONS below <br />If yes, describe under <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />$ <br />$ <br />$ <br />E.L. DISEASE - POLICY LIMIT <br />E.L. DISEASE - EA EMPLOYEE <br />E.L. EACH ACCIDENT <br />ER <br />OTH- <br />STATUTE <br />PER <br />LIMITS(MM/DD/YYYY) <br />POLICY EXP <br />(MM/DD/YYYY) <br />POLICY EFF <br />POLICY NUMBERTYPE OF INSURANCELTR <br />INSR <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />EXCESS LIAB <br />UMBRELLA LIAB $EACH OCCURRENCE <br />$AGGREGATE <br />$ <br />OCCUR <br />CLAIMS-MADE <br />DED RETENTION $ <br />$PRODUCTS - COMP/OP AGG <br />$GENERAL AGGREGATE <br />$PERSONAL & ADV INJURY <br />$MED EXP (Any one person) <br />$EACH OCCURRENCE <br />DAMAGE TO RENTED <br />$PREMISES (Ea occurrence) <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS-MADE OCCUR <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY PRO- <br />JECT LOC <br />CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MM/DD/YYYY) <br />CANCELLATION <br />AUTHORIZED REPRESENTATIVE <br />ACORD 25 (2016/03) <br />© 1988-2015 ACORD CORPORATION. All rights reserved. <br />CERTIFICATE HOLDER <br />The ACORD name and logo are registered marks of ACORD <br />HIRED <br />AUTOS ONLY <br />Hillsborough NC 27278 <br />PO Box 8181 <br />Orange County Emergency Services <br />The certificate holder is also listed as additional insured with respects to the general liability and professional liability <br />Orange County, NC <br />P.O. Box 8181 <br />Hillsborough, NC <br />01/17/202301/17/2022999033014 <br />Surety Bond <br />C <br />1,000,000 <br />1,000,000 <br />1,000,000 <br />8 <br />10/1/202310/1/2022WC027-00001-021YD <br />2,000,000 <br />2,000,000 <br />01/10/202301/10/2022ENV562008435-00 <br />8 <br />A <br />1,000,000 <br />12/04/202212/04/2021063493008B <br />1mill occ/2mill aggPollution Liability/Mold <br />2,000,000 <br />2,000,000 <br />1,000,000 <br />5,000 <br />50,000 <br />1,000,000 <br />01/10/202301/10/2022ENV562008433-00Y <br />8 <br />Professional Liability- Claims Made8 <br />8 <br />8 <br />A <br />34762SunZ Insurance <br />Ohio Casualty <br />Progressive Insurance <br />GuideOne National Insurance Company <br />27705NCDurham <br />4122 Bennett Memorial Rd Unit 207 <br />4C Central Cleaning Company Inc DBA Final Passage Transport <br />alexandra@cavikinsurance.com <br />9103981044 <br />Alexandra Lysik <br />28449NCKure Beach <br />PO Box 465 <br />Cavik Insurance LLC <br />10/10/2022 <br />DocuSign Envelope ID: 118ABACD-860B-4164-94A6-9107E0858477