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.4COR0 CERTIFICATE OF LIABILITY INSURANCE <br />�� <br />D /DD/YYYY) <br />3//27/27/ 2014 <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(les) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the 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 <br />Grayling Insurance Brokerage <br />450 Northridge Parkway <br />Suite 102 <br />Atlanta GA 30350 <br />Co MT CT T Jerry NOyOla <br />NA <br />PHONE (770) 552 -4225 FAX (966) 550 -4092 <br />ppgE .Jerry- noyola @greyling.com <br />INSURER(S) AFFORDING COVERAGE <br />NAIC N <br />INSURERANational Union Fire Ins Cc <br />19445 A <br />INSURED <br />Kimley -Horn and Associates, Inc. <br />P.O. Box 33068 <br />Raleigh NC 27636 <br />INSURER B:COmmerCa & Industry Insurance <br />17410 A <br />INSURERCNew Hampshire Insurance Company <br />3841 A <br />INSURER D:Llo dIs of London <br />085202 A <br />INSURER E: <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE � OCCUR <br />INSURERF: <br />GUVCKAUt:5 CERTIFICATE N(1MSFR-,14 -15 ( Kimlev Melaniel DFVISInIU w IMRI =o• <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 <br />LTR <br />TYPE OF INSURANCE <br />ADDLSUBR <br />POLICY NUMBER <br />POLI pY EFF <br />POLICY 1 EXP <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1,000,000 <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE � OCCUR <br />9645227 <br />/1/2014 <br />/1/2015 <br />A RENTED <br />I <br />$ 500,000 <br />MED EXP (Any one person) <br />$ 25,000 <br />PERSONAL& ADV INJURY <br />$ 1,000,000 <br />X Contractual Liability <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />GE N'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP /OP AGG <br />$ 2,000,000 <br />POLICY X PRO X LOC <br />$ <br />AUTOMOBILE <br />LIABILITY <br />Ea COMB SINGLE LIMIT <br />1 000 000 <br />BODILY INJURY (Per person) <br />$ <br />A <br />AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />4982985 <br />/1/2014 <br />/1/2015 <br />IxANY <br />BODILY INJURY Per accident <br />( ) <br />$ <br />X NON -OWNED <br />HIRED AUTOS AUTOS <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />X <br />UMBRELLA LIAB <br />X <br />OCCUR <br />EACH OCCURRENCE <br />$ 5,000,000 <br />AGGREGATE <br />$ 5,000,000 <br />B <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED I X I RETENTION 10,00 <br />$ <br />E58430948 <br />/1/2014 <br />/1/2015 <br />C <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />ANY PROPRIETOR/PARTNEWEXECUTIVE <br />OFFICER/MEMBER EXCLUDED9 N <br />(Mandatory in NH) <br />If yes, describe under <br />DESC RIPTION OF OPERATIONS below <br />NIA <br />W 018112556 (AOS) <br />018112557 (CA) <br />/1/2014 <br />/1/2014 <br />/1/2015 <br />/1/2015 <br />X I WCSTATU- I OTH- <br />TORY LIMITS FIR <br />E.L. EACH ACCIDENT <br />$ 1,000,000 <br />E.L. DISEASE - EA EMPLOYEE <br />$ 1,000,000 <br />E.L. DISEASE - POLICY LIMIT <br />$ 11000,000 <br />D <br />Professional Liability <br />B0879PO70831401 <br />/1/2014 <br />/1/2015 <br />Per Claim $2,000,000 <br />Aggregate $2,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) <br />For Proposal Only <br />AI.UKU LD (LU1 U 1U5) <br />INS025 (2ntnmi m <br />VAIYVCLLA <br />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 />AUTHORIZED REPRESENTATIVE <br />Collings /JERRY <br />©1988 -2010 ACORD CORPORATION. All rights reserved. <br />Tho A(.npn nnmo and Inn^ nro roniefororl marlrc of Arnpn <br />