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Docusign Envelope ID: B585AFF7-3200-4914-9ADB-7BC32036B13D
<br /> �� �� CERTIFICATE OF LIABILITY INSURANCE DATEIMMIDO/YYYY)
<br /> � a;1 I12ozs
<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: It the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)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 endorsernent(s),
<br /> PRODUCER GVNIAc
<br /> NAME: qunalri Mor)an
<br /> ',Aorgan&..&%( late Insur,,mrc Group•GA AIC No,Eat): (710)917-154 7 �(A/c.No, (lifob)70-6I'll
<br /> PO Iloti 5'RI3 ADORE5S; d,>SUtH It}ruurs)N„uranCC uMtt
<br /> INSURERIS)AFFORDING COVERAGE NAIC A
<br /> flr5ug;la�tili,: GA 30154 INSURER A: I-WINCITI'FIREINSCo('0 29459
<br /> INSURED INSURERO; LLOYDS OF LONOON
<br /> �,Irdts,dan.�,,Inz INSURER C THE HARTFORD
<br /> I 1 z ,:t,i rn<h INSURER a
<br /> INSURER E;
<br /> Es .ne,ts;n NC 2721)._70 INSURERP
<br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br /> THIS IS TO GFRT it'=Y THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br /> INDICATED, NOTWITHSTANDING ANY REOUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTtIER DOCUMENT WITH RESPECT TO WHICH THIS
<br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED IiEREIN IS SUBJECT TO ALL THE TERMS,
<br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> LTR TYPE OF INSURANCE INSD WVD. POLICY NUMBER IR9M/DDIYYYYI MMIDD;y 111 LIMITS
<br /> Tx COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 1()0U t)()0
<br /> !� CLA4ME MAi3f l3C.CUR PREMIX ES(Ea com once) 5 � 100,000
<br /> l NIED EXh(AnY doe parson) 8 .500(1
<br /> I3 _—�— �— (;AII-)')I51-241121 11 21i2W4 (112112025 PERSONAL&ADVINJORY 5 1,000,000
<br /> GEN'L AGOREG,ATE LIMIT APPLIES PER' _ GENERAL At'VRIEOATE S 3,00,000
<br /> POLICY JECTPRta- LOC PRODUCTS•COMP/OP AGO S 1,000,000
<br /> fit[ OTHER: Plwysieal and Scxuul Ahmo Pbyslcul and Srsuai Abits 5
<br /> AUTOMOBILE LIABILITY A(tr Y "' t" 5 f 500 ,
<br /> _ f(Pa ncc.aent _
<br /> ANY AUTOBODILY INJURY(per person) S
<br /> OWNED Ct EOULEI� ('� �
<br /> ( AU'rOS ONLY AU110S I 70PH 2i'111710 A3.11120_"1 t13=112ir iPOhH.Y INJURY(Per dctydwll) S --
<br /> ((—'')HIRED NON-OWNED '4� i'"-'L-T{ UAw ua. S
<br /> AVTOS ONLY AUTOS ONLY ipu aCC.dent) 5
<br /> UMBRELLA LIAR OCCUR _ -)EACH OCCURRENCE S
<br /> EXCESS IIAe CLAIMS-MAOE i AE GRE0,ATF g
<br /> .OFD77T—
<br /> RETENTIONS 5 - -
<br /> WORKERS COMPENSATION
<br /> iAND EMPLOYERS'LIABILITY YIN ' STATt1TE ER -
<br /> ANY h(`f RIETOH+i'kRI NER 9'F(,JMVE — 1 _ 16.1 f AC4'1 Ai 00VNT 5 I AAU t!(I�..
<br /> A FF(CER/MEMBEREXCLUDEDY �NtA 20W1(AWIXAU U_ll(t 2,025 W H'i?0?(i
<br /> Mandatory In NH) ,F i 01yEASE EA EMPLOYEE S 1,000.000
<br /> ._.
<br /> I Ve! dasfnbe t/nd8r -.. -..,.,.-.:-..__.:,.,-•--.__.,_.,....-...—
<br /> OE CRIPTION OF OPERATIONS brtuw !F L.DISEA'3E.POLICY LIMIT 5_ f 0A0,A00
<br /> 1
<br /> I3 i'Ii7fession;+fLia1>ility GAII-991a1-24112) I1,21:2024 11 21120215 j 51,00(i3OOgilcc
<br /> 53.00(1d)Ot)agg
<br /> DESCRIPTION CP OPERATIONS/LOCATlON9!VEHICLES (ACORD tlti,Additional Ren.arks Schodule,may bo attached if more space is requimd)
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Orange County,its OIticers,agents and employ'.es are to be Oesignated a:= THE EXPIRATION DATE-THEREOF,NOTICE WILL BE DELIVERED IN
<br /> "additional insured"Oringe County NC ACCORDANCE WITH THE POLICY PROVISIONS,
<br /> 300\tVest Tryon Street AUTHORIZEO REPRESENTATIVE.
<br /> P.O.Box 81,41
<br /> Hillsborough NC 27278 Ian„,I,tr4J P9n;ar,r
<br /> 9 1988.2015 ACORD CORPORATION. All rights reserved,
<br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
<br />
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