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AMERICAN4 <br />CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MMIDD/YYYY) <br />W30/2024 <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 />PRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />ORTANT: 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 endorsementrsl- <br />PRODUCER <br />Commercial Lines — (404) 923-3700 <br />US] Insurance Services LLC <br />1 Concourse Parkway NE, Suite 700 <br />c EACT Jennifer Shiplet <br />PHONE FAX <br />Eat: 470-875-0358 Na; 610-537-1929 <br />ENo <br />ADDRESS: jennifer.shi*Wusi.com <br />INSURER(S) <br />NM <br />Atlanta, GA 30328 <br />_ <br />Insurance <br />�r�A; ACE American InsurarXx Company <br />22667 <br />INSURED <br />American Cancer Society, Inc. <br />INSURER 8: Evarlslon Insurance Company, <br />35378 <br />INSURERC: <br />270 Peachtree Street NW. Ste 1300 <br />Atlanta, GA 30303 1 INSURER F <br />COVERAGES CFRTIFICATF NIIMRFR• 15894471 RPVIQVIM MN mRCD. Sm hd.w. <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 />INSIR LTR <br />TYPE OF INSURANCE <br />ADDL <br />SUER <br />POLICY NUMBER <br />MM ayTYT <br />POLICY QP <br />UNITS <br />A <br />X <br />CNM3CIALGENERALLL400JY <br />CLAIMS -MADE IX I OCCUR <br />HDO G48948637 <br />09/01/2024 <br />09/01/2025 <br />EACH OCCURRENCE <br />S 11000,000 <br />PREMISES tE. ommarlL9 <br />$ 300,000 <br />►1ED EXP(My me ptysorr) <br />$ 2,500 <br />PERSONALSADVINAIRY <br />E 1.0110.000 <br />GEML <br />AGGREGATE LINT APPLIES PER, <br />Fyl POLICY J I � Fx� LOC <br />OTHER <br />GENERAL AGGREGATE <br />s 25•0WADO <br />PRODUCTS -COMPIOPAGG <br />E Z000.000 <br />S <br />X7AUT, <br />LIN1eun <br />O <br />SCHEDULED <br />NLY AUTOS <br />NON4YWNED <br />X AUTOS ONLY <br />ISA 1411372958 <br />09/01/2024 <br />09/012025 <br />COMBINED SINGLE GtE LIMIT <br />E 1,000,000 <br />BODILY INJURY (Perpaa ) <br />$ <br />f10DAY INJURY (Paamdctl) <br />E <br />XNLY <br />PROPERTY DAMAGE <br />$ <br />S <br />B <br />X <br />UNBR LIAB <br />EXCESS LMIB <br />X <br />OCCUR <br />CIAMSalAOE <br />MKLV2EUL106D81 <br />09/01/2024 <br />09/01/2025 <br />EACH OCCURRENCE <br />S 1,000,000 <br />X <br />AGGREGATE <br />S 1,000,000 <br />DED I X I RETENTIONS 10.0m <br />$ <br />A <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS• LIABILfrY YIN <br />...E EMREREXCwoF�� C <br />(Mandatory m NH) <br />tt yes. tlesmibe undar <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />WLR C72621529 AOS <br />( ) <br />SCF C72621566(FL-OK-OR- <br />09/01/2024 <br />09/01/2024 <br />09/012025 <br />09/012025 <br />X TAATUTE E°R <br />E.L EACH ACCIDENT <br />E t•DDD•00D <br />E.L. DISEASE -EAEMPLOYEE <br />E 1.0W000 <br />E.L. DISEASE-POUCYLMIT <br />E 1,OW.000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES 1ACORD 101, AddMonW Remoras Schadule, may be abached a more space Is r uhed) <br />Evidence of Insurance <br />American Cancer Society, Inc. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Peachtree Street NW THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />300 <br />farta, GA 30303 AUTHORIZEDREPRESENTATIVE <br />The ACORD name and logo are registered marks of ACORD ©1988.2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) <br />