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SEP-18-2012 09:01 From:Herrin9 and Bickers 9194791868 To:9196443001 Pa9e:2f2 <br /> °® CERTIFICATE OF LIABILITY INSURANCE DATE(MM10DlYYYY) <br /> 09/18/2012 <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(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br /> the terms and conditions of the policy,certaln 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 CONTACT <br /> NAME: ....._ <br /> Herring 8 Bickers Insurance Agnecy PHONE 91 <br /> AAIC, <br /> C.,):( 9)479-9900 (A/C NQ);(919)479-1$08 <br /> 2344 Operations Drive E-MAIL <br /> Suite 101 ADDRESS: <br /> Durham, NC 27705 _,_ INSURER(SI AFFORDING COVERAGE NAIC a <br /> INSURER A:ERIE IN,S EXCH <br /> INSURED INSURER 8:ERIE INS EXCH <br /> Hudson Well Co-, Inc. <br /> INSURER C; _..... ', <br /> P O Box 5 IN uRER D: Erie Insurance Group <br /> Rougemont, NC 27572-0005 <br /> ENSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <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 'IHt NULIGIES UESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLU51ONS AND CONDITIONS OF 3UCI I POLICIES.LIMITS SHOWN MAY HAVE BEEN REDVCED BY PAID CLAIMS. _ <br /> IN9R I TYPE OF INSURANCE ADDL 3UBR --- 60 ICY 11FF POLICY EEXP <br /> LTR POLICY NUMBER MM/DD MM/DD/YYYY LIMITS <br /> A GENERAL LIASILITY 0442450218 8/2412012 ! 8/2412013 EAQI OCCURRENCE $ 1000000 <br /> DAMAGE T tt�11 <br /> T COMMERCIAL GENERAI LIAMUTY PREMISES(Ea occulted $ _ 1000000 <br /> CLAIMS-MADE h OCCUR MED EXP(Any one person) S 55000 <br /> PERSONAL&ADV INJURY S _ 1000000 <br /> _ GENERAL AGGREGATE $ 2000000 <br /> GCN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2000000 <br /> T POLICY F PRO- LOC $ <br /> F3 AUTOMOBILE LIABILITY 0082440007 8/2412012 8124/2013 COMBINED SINGLE LIMII 750000 <br /> ANY AUTO BODILY INJURY(Her person) $ <br /> ALL OWNEO X I SCHEOUI FD OODILY INJURY(Per accident) S <br /> AUTO$ AU rOS _.._ <br /> NON-OWNFh PROPERTY DAMAGE S <br /> X - HIRED AUTOS X AUTOS Per xcidenf). ...-- <br /> $ <br /> UMDRGLIa L1As gCCUK IEACI I OCCURRCNCC S _ <br /> EXCESS LIAB CLAIMS MADE AC.iGREGAl'l;. _ S <br /> DtU RETENTION 3 $ <br /> D WORKERS COMPENSATION 09224005518 8/24/2012 8/24/2013 X( I vuf;STATU- i ery- <br /> AND EMPLOYERS LIABILITY <br /> ANY PROPRIETORIPAR I Nlik/EXECUTIVE Y f N E L EACH ACCIDENT $ 100000 <br /> OGFICEPUMCMDCR EXCLUPF[ NIA <br /> °- -•• <br /> (Mandatory In NH) E L DIS_EASF-EA EMPLOYE S 100000 <br /> If Yes d—cnna under i 5500000 <br /> DESCRIP'I•]ON OF OPERATIONS below E,L DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS t LOCATIONS t VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) <br /> Re: Operations usual to water well drilling contractors. <br /> Officer/s are excluded from Work Comp coverage. <br /> CERTIFICATE HOLDER CANCELLATION <br /> (919)644-3001 SHOULD ANY OF THE ADOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE THEROOF, <br /> Ora ge County ACCORDANCE EXPIRATION POLICY PROVISIONSE WILL BE DELIVERED IN <br /> Attn:Jeff Thompson <br /> P 0 BOX 81$1 AUTHORIZED REPRESENTATIVE <br /> Hillsborough, NC 27278 <br /> 01888-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 26(20"10105) The ACORD name and logo are registerod marks of ACORD <br />