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DocuSign Envelope ID : 22DOBF22-BF984108-ADE4 -6A6lC59DB4DA <br /> --"', CLARASS =01 KKEMP <br /> ACORO CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) <br /> mom 4/4/2023 <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 PFS Insurance <br /> NAME: <br /> PFS Insurance Group PHONE FAX <br /> 4848 Thompson Parkway Suite 200 (A/C , No, EXt) : (970 ) 635 -9400 (A/C, No) : (970 ) 635-9401 <br /> Johnstown , CO 80534 aI DRIESS . info@mypfsinsurance . com <br /> INSURERS AFFORDING COVERAGE NAIC # <br /> INSURER A : Old Guard Insurance Company 17558 <br /> INSURED INSURER B : Pinnacol Assurance Co 41190 <br /> Clarion Associates LLC INSURER C : Houston Casualty Company 42374 <br /> 1600 Stout Street, Ste #1700 INSURER D : <br /> Denver, CO 80202 <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 IN SD WVD MM DD MM DD <br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 21000 , 000 <br /> CLAIMS-MADE X OCCUR 042989M 8/11 /2022 8/11 /2023 DAMAGE TO RENTED 500 , 000 <br /> X PREMISES Ea occurrence $ <br /> MED EXP (Any oneperson) 51000 <br /> PERSONAL & ADV INJURY $ 2 , 0001000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 41000 , 000 <br /> POLICY ❑X ECOT- LOC PRODUCTS - COMP/OP AGG $ 21000 , 000 <br /> OTHER: $ <br /> A COMBINED SINGLE LIMIT 130005000 <br /> AUTOMOBILE LIABILITY Ea accident $ <br /> ANY AUTO 042989M 8/11 /2022 8/11 /2023 BODILY INJURY Perperson) $ <br /> OWNED SCHEDULED <br /> AUTOS ONLY AUTOS BODILY INJURY Per accident $ <br /> X AUTOS ONLY XI <br /> AUTOS ONLY Peoacciden DAMAGE $ <br /> A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 21000 , 000 <br /> EXCESS LIAB CLAIMS-MADE 042989M 8/11 /2022 8/11 /2023 AGGREGATE $ 21000 , 000 <br /> DED X RETENTION $ 0 <br /> B WORKERS COMPENSATION X <br /> AND EMPLOYERS' LIABILITY STA O STATUTE ERH <br /> ANY PROPRIETOR/PARTNER/EXECUIIVE Y 4060755 7/1 /2022 7/1 /2023 E. L. EACH ACCIDENT $ 1 , 000 , 000 <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 /> Professional Errors H722 -120205 9/22/2022 9/22/2023 Each Claim 21000 , 000 C0 <br /> DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES ACORD 101 , Additional Remarks Schedule, may be attached if more space is required) <br /> Cyber Liability: Policy Number: CYB-3018599 -0 ; Eff/Exp Date : 06/16/2022 - 06/1612023 ; Each Claim $ 1 ,000, 000 Hudson Excess Insurance Company NAIC <br /> #14484 <br /> If required by written contract, Orange County is included as Additional Insured for ongoing operations under General Liability. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Orange County Planning & Ins Inspection Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> g g p p ACCORDANCE WITH THE POLICY PROVISIONS . <br /> 131 West Margaret Lane Suite #201 <br /> Hillsborough , NC 27278 <br /> AUTHORIZED REPRESENTATIVE <br /> ACORD 25 (2016/03 ) © 1988 =2015 ACORD CORPORATION . All rights reserved . <br /> The ACORD name and logo are registered marks of ACORD <br />