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DATB (MM/DD/YYI <br />..... ........ ~......a ... i'it .4~' ,A~,k. 'vh•.. :\hi+ti:~.4~-{.' .. }. , v.}, 0 8 0 3 9 9 <br />~iiouucBR THIS CERTIMCATE IS ISSUED AS A MATTER OFINFORMATION <br />HAYWOOD S IMPSON INS AGCY INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> HOLDER. THIS CERTIFICATE DOES NOT AMEND, EX'CENDOR <br />1105 S CHURCH STREET ALTER THE COVERAGE AFFORDED BY TETE POLICIESSELOW. <br />P O BOX 2 0 3 8 ~ COMPANIES AFFORDING COVERAGE <br />BURLINGTON NC 27216 . ~A,,IY <br /> A PENN AMERICA INS CO <br />INSURED <br />eoMPANY <br />JAMES STEWART B NATIONWIDB INSURANCB <br />DBA FAIRVIEW EAGLES CLUB ~,I,r,r <br />520 HARPER STREET C <br />HILLSBOROUGH NC 27278 ~,ulY <br /> D <br />:~0~.'•r'~C'v ..~s..~t~'.' ..R,b~:. ~'i.• :c:'.~vC'...::.s:4:??2 .. .Aw <br />THIS LS TO CERTtF1l THAT THE POLICES OF INSURANCE LLS'f® BELOW HAVE BEEN ISSLIBD TO THB INSURID NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. N07VIRfHSTANDING ANY REQ[JIRF1rIffiVT. TBRM OR CONDTTION OF ANY CONTRA(3T OR OTHER DOCUMENT WTIH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDI(D BY THE POLICII~ DffiCRIB® HERBIN 4T SUBIBCI' TO AIL THE TERMS <br />, <br />EXCLUSIONS AND CONDTRONS OF SUCH POLICDS. LII~sTIS SHOWN MAY HAVE BEBN RBDUC® BY PAID CLABrIS. <br />CO <br />LnE Tors of INStmANCe roucY NUMBER rouclr snscnvs <br />DATE pOUDD/YY) PowcY salw-no <br />DATE piSM/DD/YY) ~~ <br /> cSNBRAL wASILmr 0 7 3 0 9 9 B INDER 7 3 0 9 9 7 3 0/ 0 0 GENIIW. AGGREGATE : 6 0 0 0 0 0 <br /> ~( COMMERCIAL GENERAL LIABBITY PRODUCTS - COMP/OP AGC S 6 O O O O O <br /> ' CLAIMS MADE ~ OCCUR PERSONAL ! ADV MIURY f 3 O O O O 0 <br /> owNeR•s ! corrlRACroR•s rROr FaaE oonmRacE s 3 0 0 0 0 0 <br /> E~tE DAMAOE (A~ me fircj f 5 0 0 0 0 <br /> M® EXP (A~ we PmcN i <br /> AUTOMOBILE LIABILITY <br /> ANY AUTO <br />COMB[N®SWGLE LBiIT <br />f <br /> ALL OWNED AUTOS <br />EIODl1 <br />Y WJURY <br /> <br />SCHEDULED AUTOS . <br />(PapeRaq- f <br /> HIRED AUI~OS <br />V <br />Y <br /> BODB, <br />B <br />IURY i <br /> NON-OWNED AIIPOS (~ ~) <br /> <br /> PROPERTY DAMAGE f <br /> GARAGB WABILTII( AUTO ONLY - EA ACCmPNI' i <br /> ANY AUTO OTHER THAN AUTO ONLY• <br /> EARL ACCEOEKI' f <br /> <br /> AGGREGATE L <br /> <br /> 6YCBS3 LIABILITY ~~ OCCURRENCE: <br /> ~~~ PoRM AGORE3iAns f <br /> OTH1R THAN UMBRFll/1 WRM f <br /> woRTTSRS coMPSNSAnon ANo <br /> <br />' <br />WC STATU- OTH- <br />i;`;~<:%;t3ii?>i::. 3 ~?:a>: z;:: <br /><:.::::.::..;::: <:.:.. -:.;..:.: •.:;;. <br /> eMPLOVSRS T.IABIwT <br />Y <br /> E1. EACH wCCIDExr f <br /> nIEPROPREE;row <br />PARTNERS/F7CECVITVE TNCT. <br />EI. DISEASFrPOwCY I.AQI <br /> <br /> OF7ICF.RS ARE QCCL EL DESFJISES-El1 Ea(PLOYEsE S <br /> DTI 073099BINDER 07 30 99 07/30 00 8,500 PER PERS. <br /> GROUP ACCIDENT <br />usscTUlmoN o` orgsAnorls~wcAnoN.vvewcLesisrecEAL ITSMs <br />COVERAGE APPLIES TO PARK PREMISES LOCATED ON HARPER STREET, HILLSBOROUGH, NC <br />.. .: ... <br /> SEOUID ANY OB nTS ABOVE DBSCRIBBD rowCIBS 8B CANCELLED BEFORE THB <br />TOWN OF HILLSBOROUGH s>~IRATTON DATE TTTEIIBOe. TTY ISSUING COMPANY WILL BPIDBAVOR Tn+AEL <br />MAYOR HORACE JOHNSON ]~Q_ DAYS WRI7TBN NOTICB TO TIIB CBRTTFICATS HOIDBJ[ NAMHD 7b TE~FI, <br /> BVI' PAILURB TO MAIL SUCH NOTTCB SEALL lMTP066 Pi0 OBwGA770N OI.EABII.ITY <br />HILLSBOROUGH NC 27278 ov ANY ~ uroN ~MPANY rrs AceNTS oR RaPRBSeNTAnvBS. <br /> AUTTiORIZ® <br /> Kevi a CPIW KR A <br />..,~_y: <br />