Engineered Solutions of Georgia

CERTIFICATE OF LIABILITY INSURANCE

DATE (MM/DD/YYYY)

02/08/2018

IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.

NAME: CONTACT

PRODUCER

Mark Mason

(A/C, No): FAX

E-MAIL ADDRESS: (A/C, No, Ext): PHONE

Sterling Seacrest Partners, Inc P O Box 724137

(678)424-6500

(678)424-6501

mmason@sspins.com

INSURER(S) AFFORDING COVERAGE

23396 NAIC #

Atlanta

GA 31139

Amerisure Mutual Insurance Co

INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A :

INSURED

Amerisure Insurance Company

19488

Engineered Solutions of Georgia Inc. 2260 Northwest Pkwy Suite H Marietta

Kinsale Insurance Company

38920

GA 30067

COVERAGES

CERTIFICATE NUMBER:

REVISION NUMBER:

17-18 Master w/Prof

THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.

ADDL INSD

SUBR WVD

LTR INSR

(MM/DD/YYYY) POLICY EFF

(MM/DD/YYYY) POLICY EXP

TYPE OF INSURANCE

LIMITS

POLICY NUMBER

COMMERCIAL GENERAL LIABILITY

1,000,000 500,000 10,000 1,000,000 2,000,000 2,000,000

EACH OCCURRENCE DAMAGE TO RENTED

$

CLAIMS-MADE

OCCUR

$

PREMISES (Ea occurrence)

MED EXP (Any one person)

$

A

CPP2105771 00 02

07/27/2017 07/27/2018

PERSONAL & ADV INJURY

$

GEN'L AGGREGATE LIMIT APPLIES PER:

GENERAL AGGREGATE

$

PRO- JECT

POLICY

LOC

PRODUCTS - COMP/OP AGG

$

$

OTHER:

COMBINED SINGLE LIMIT

OWNED ANY AUTO AUTOMOBILE LIABILITY

1,000,000

$

(Ea accident)

BODILY INJURY (Per person)

$

SCHEDULED

B

CA 2105770 00 01

07/27/2017 07/27/2018

PROPERTY DAMAGE BODILY INJURY (Per accident)

$

AUTOS ONLY HIRED AUTOS ONLY

AUTOS

AUTOS ONLY NON-OWNED

$

(Per accident)

$

EXCESS LIAB UMBRELLA LIAB

5,000,000 5,000,000

OCCUR

EACH OCCURRENCE

$

A

CU 2105772 00 02

07/27/2017 07/27/2018

CLAIMS-MADE

AGGREGATE

$

DED

RETENTION $

$

WORKERS COMPENSATION AND EMPLOYERS' LIABILITY

STATUTE PER

ER OTH-

Y / N

1,000,000 1,000,000 1,000,000

OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE

E.L. EACH ACCIDENT

$

N / A

B

N

WC 2106250 00 01

10/01/2017 10/01/2018

E.L. DISEASE - EA EMPLOYEE

$

E.L. DISEASE - POLICY LIMIT

$

Each Claim

1,000,000

Professional Liability

C

0100008482-6

07/27/2017 07/27/2018

Aggregate

1,000,000

Deductible

10,000

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

RE: Nicholas Crispell

CERTIFICATE HOLDER

CANCELLATION

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.

Professional Licensing Board Residential and General Contractor’s Board 237 Coliseum Drive

AUTHORIZED REPRESENTATIVE

Macon

GA 31217

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ACORD 25 (2016/03)

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