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A C° ® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDYWYY) <br />�1 04109/2014 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE BOLDER. 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 be endorsed. If SUBROGATION IS WAIVED, subject to the <br />terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER CONTACT <br />NAME: <br />Allen C Lewis A Agency PP NE FAX <br />{ A IC Na Ext): - [A1C, Na <br />2007 BOULEVARD ST E -MAIL <br />ADDRESS: <br />STE U INSURERS) AFFORDING COVERAGE _ NAIC O <br />GREENSBORO NC 27407 INSURER A NATIONWIDE MUTUAL FIRE INSURAN COM PA1123779 <br />INSURED — - - _ INSURER B <br />DAVID P GRANT INSURER C <br />DBA GRANTS SERVICE CO INSURER D <br />4122 pUARTERSTAFF CT INSURER E <br />HIGH POINT NC 27265-8005 INSURER F <br />r' f1\/FROrr.II r'FRTIFIr ATF h1IIMRFR• !2F \Ilfilr)hl hil IMRPP- <br />THIS 1S 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 T1 1E TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />TYPE OF INSURANCE SR WV0 _ - -- POLICY NUMBER MMID I JMM/DDNYYYl LIMITS — <br />I LTR N <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 500,000 <br />X COMMERCIAL GENERAL LIABILITY <br />CLAiMSMADE n OCCUR <br />F- <br />D4MAT (RENTED <br />PREMI E SES[EanccurrenCe <br />MED EXP (Any one person) <br />-- <br />$ 100,000 <br />s 5,000 <br />PERS 11 A DV I S 500,00 <br />A <br />ACP GLGO 2262966927 <br />0111212014: <br />0111212015 <br />GENERALAGGREGATE ,S 500,000 <br />GEN'L AGGREGATE LIMIT AP PER : <br />PRODU COM PIOPAGG <br />j $ 500,000 <br />' <br />POLICY, JEa Lot- - <br />- - <br />S - <br />AUWMOBILE <br />LIABILITY <br />F <br />COMB NEn Si IJC3LE LIM ET <br />Ea accident) <br />5 <br />ANYAUTO <br />_ <br />BODILY INJURY (Per person) <br />S <br />Y <br />ALLOVVh1ED SCHEDULED <br />AUTOS AUTOS <br />HODILY INJURY (Per accident) <br />5 <br />(JON- OVVNED <br />PROPERTY DAMAGE <br />I HIRED AUTOS II AUTOS <br />I F — <br />Peraccident <br />S <br />UMBRELLA UAB <br />OCCUR <br />I <br />I <br />EAC O CCUR RENC E <br />S <br />$ <br />EXCESS LIAB <br />CLAIMS-MADE <br />AGGREGATE <br />DED RETENTION $ <br />S <br />WORKERS COMPENSATION <br />OTR <br />AND EMPLOYERS' LIABILITY YIN <br />WRY LIMITS <br />- - <br />E.L. EACH ACCIO ENT <br />S <br />ANY PRCPRIETORlPARTNERIEXECUTIVE <br />OFFICEIMEMBER EXCLUDED? <br />NIA <br />E.L. DISEASE -EA EMPLOY <br />5 <br />(Mandatory in NH) <br />Ilyes, descnbe under DESCRIPTION O= OPERAT IO' IS below <br />E DISEASE - POLICY LIMIT <br />$ <br />I <br />F �1 <br />I <br />DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />CERTIFICATE HOLDER CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />CCTS THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />1303 S. CANNON BLVD. <br />KA NC 28083 AUTHORIZED REPRESENTATIVE <br />Alusia R. McCracken <br />@ 1988 -2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2410105) The ACORD name and logo are registered marks of ACORD Attachment number 2 <br />F -5 Page 2 <br />