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Erie CERTIFICATE QF INSURANCE <br />(nSUI'anCG -THIS CERTIFICATE IS ISSUED A$ A MATTER OF INFORMATION ONLY - <br />Home Office • tOD Erie Insurance Place • Erie, Pennsylvania 16530 • 814.870.2000 <br />Toll free 1.800.458.0811 • Fax 814.870.3126 • www.erfeinsurance.com <br />DATE ISSUED (MM/DD/YY) <br />1/13/12 <br />NAMEANDADDRESS OF AGENCY CARL A WALKER INS AGENCY INC AGENT'S N0. <br />210 W CLAY ST JJ1117 <br />MEBANE, NC 27302-2434 of p cab e <br />EXCHpNe E <br />Co.; E ErfeElaN <br />m~l C~ <br />l <br /> o <br />r <br />e <br />in-Fact <br />(919)563-0051 <br /> <br />NAME AND ADDRESS OF NAMED INSURED This certficate rs lasued for information w <br />p poses onl~~rr and eoMers <br />no rigght <br />s <br />on the certificate hold <br />It d <br /> er. <br />oes not attlrmaiivet or <br />R S JONES & ASSOCIATES INC lI <br />yy <br />id~ <br />N <br />i <br />~ <br />m <br />s o <br />i <br />su <br />o <br />e <br />~ <br />H <br />e <br />~ <br />y <br />~ <br />p <br /> <br />121 W CLAY ST STE A a <br />c <br />ondit <br />a <br />i <br />~ <br />n <br />r <br />alice C <br />v <br />r <br />agg <br />ee <br />co <br />idained ip the <br />pog <br />cy <br />esj <br />Indicated below. The terms and conditloss of the pagcy(ies) <br />overn <br /> <br />MEBANE <br />NC 27302 g <br />the insurance coverage as applied to any given aitsatlon. Umfta <br />, shown may have been reduced by clams paid. This certificate of <br /> insnrance does not constitute a contract between the Issuing <br /> Insurarls), authorised representative or producer and the <br /> <br />Is is th Ce Kies as n the P Number bebw are bl f~ the ed rtstt at th eertiiicalle holder. <br />e time that the Certlflcate Is bel ue <br /> <br />TYPE OF I E PODGY NllMBER <br />E 4~NERAI LIABIt.iTY . <br />~~ <br /> <br />6/16/12 <br />CoNNERgpLGelEwu.uAellm Q42 1690212 6/16/11 EACH OCCURRENCE 2 000 000 <br />i <br />^ CWMS MADE Q OCCU FIREDA6WGE OneFiro 2 000 000 <br />i <br />^ MED EXP One 5 000 <br /> <br />^ PERSONAL&ADV.INJURY 2 000 000 <br /> <br />GEN LAGGREGATELaNRAPPLIES GEIdg1ALAGGR~AiE 4,000,000 <br /> <br />® POLICY ^ PpQECr ^ LOC PRODUCTS-COMP/OPAGG 4 000 000 <br />E AUi0NI0811E LIABILITY <br /> •ANypmp•~~l Q061630431 6/16111 6/16/12 ~ $ <br /> ^ OWNED BODO.YINJURY <br /> $ <br /> HIRED <br /> PROPFAT1f DAMAGE S <br /> NON-OWNED BOOILYMtJURYAND <br /> GARAGE ~ ~ S 1,000,000 <br />E ^ EXCESS LU-BIUTY <br /> <br />OCCURR Q30 1670212 6/16/11 I 6/16/12 EACHaf~REN 3 000 000 <br /> ENCE AGGREGATE 3 000 000 <br /> RETEN <br /> nON $ <br /> <br />E WORKERS COMPENSATIOtI A <br />90 2100491 6/21!11 ~ 6/2 t/12 <br />EMPLOYERS LIABILITY Q ACgDENT S 500,000 EAgt ACCIDENT <br />ODILY <br />NJDIIY DISEASE S 500,000 POLICYUMti <br />BY DISEASE S 500,000 EACH EMPLOYEE <br />OTHER <br />j <br />i <br />I <br />DESCRIPTION OF OPERATIONS/LOCAiIONSNEFNCtES/EXCWSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br />Orange County is an Additional Insured per CG2010 07/04 <br />realr.Fr ~ nTmiv CWf1111 A A\IV ncTUe eern~e ncnnn.n~ ............._ __ _...__.. __ ______ <br />---------• •-•-• •- ~~~ • ~~ ~ ~~~.+~~.~ u~a~n~ocu ruLltaW ut t:Klv~tLLtU BttUHE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIV- <br />ERED INACCORDANCE WITH THE POLICY PROVISIONS. <br />nnrvn~r~nr terms andreonditions of the policy ert8 nl poi c es~ aypequire an endo sementrA st t merit on~this cart ficate does no~confer <br />rights to the certificate holder fn lieu of such endorsement(s). <br />NAME AND ADDRESS OF CERTIFICATE HOLDER <br />ORANGE COUNTY <br />131 W MARGARET LANE <br />1'O BOX 8181 <br />HILLSBOROUGH, NC 27278 <br />AUTHORI REPRESENTATIVE,. <br />i ~ e_ <br />Page 1011 <br />