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Client#: 647918 EXCELINC2 <br /> ACORD.,, CERTIFICATE OF LIABILITY INSURANCE DAf gYYYY) <br /> 3/19/2022026 <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 any rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER NAME:ACT <br /> Claudia McCoy <br /> Marsh &McLennan Agency LLC PHONE _ FAX <br /> P. O. Box 6087 MAI L'Ext: A/C,No <br /> ADDRESS: Claudia.McCoy@MarshMMA.com <br /> 206 Exchange Place <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> Huntsville,AL 35813-0087 INSURER A:Alabama Self Insured WC Fund 999999 <br /> INSURED INSURER B:Mid—st Employers Casualty <br /> Excellance, Inc. <br /> INSURER C <br /> 453 Lanier Road <br /> INSURER D: <br /> Madison,AL 35758 <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 CONTRACTOR 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 INSR WVD POLICY NUMBER MM/DD MM/DD <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ <br /> CLAIMS-MADE OCCUR PREMISES(E.RENTED <br /> ) $ <br /> MED EXP(Any one person) $ <br /> PERSONAL&ADV INJURY $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ <br /> PRO- PRODUCTS-COMP/OP AGG $ <br /> JECT LOC POLICY <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> Ea accident $ <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> A WORKERS COMPENSATION Y P105779AL2026 1/01/2026 01/01/202 X PER OTH- <br /> AND EMPLOYERS'LIABILITY STATUTE ER <br /> B ANY PROPRIETOR/PARTNER/EXECUTIVE_N Y PWAL129001 1/01/2026 01/01/202 E.L.EACH ACCIDENT $1,000,000 <br /> OFFICER/MEMBER EXCLUDED? N N/A <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 /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> The Alabama Self-Insured Worker's Compensation Fund waives the right to bring an action <br /> against Certificate Holder to enforce any right of subrogation,which may arise from Alabama <br /> Self-Insured Worker's Compensation Fund's payment of workers compensation benefits.This <br /> waiver does not affect(1)the right of an employee of Member to bring an action for damages, <br /> or(2)Alabama Self-Insured Worker's Compensation Fund's right to intervene in such action to <br /> (See Attached Descriptions) <br /> CERTIFICATE HOLDER CANCELLATION <br /> Orange Count SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> g y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> 300 West Tryon Street ACCORDANCE WITH THE POLICY PROVISIONS. <br /> P.O. Box 8181 <br /> Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE <br /> ©1988-2015 ACORD CORPORATION.All rights reserved. <br /> ACORD 25(2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD <br /> #S15537891/M 15419541 J KCXM <br />