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OP ID: LH
<br /> ACORN" CERTIFICATE OF LIABILITY INSURANCE DATE(MM27ID IDD/YYYY)
<br /> 05/
<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, certain 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 Phone:919-682-4814 NAME:c' Lee Hammond
<br /> The Sorgi Insurance Agency PH ONE FAX
<br /> 16 Consultant Place Suite 102 Fax:919-682-4906 AIC No El l:919-682-4814 /vc No):
<br /> Durham,NC 27707 E MAIL
<br /> James E.Sorg!,CIC PRODU- CE Lee@sorgiinsurance.com
<br /> R
<br /> CUSTOMER ID#:COULJEW
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURED Coulter Jewell Thames, PA INSURER A:Erie Insurance Exchange 26271
<br /> PO Box 912 INSURER B:Lloyd's of London
<br /> Durham,NC 27702
<br /> INSURER C
<br /> INSURER D:
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN 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 /> INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP 1 LIMITS
<br /> LTR 1 POLICY NUMBER MM/DDIYYYY MM/DD/YYYY
<br /> GENERAL LIABILITY - I EACH OCCURRENCE $ 2,000,00
<br /> A X COMMERCIAL GENERAL LIABILITY X 'Q470191663 1', 11/01/2013111/01/2014 rpREMISES Ea occurrence) $ 2,000,00
<br /> CLAIMS-MADE I OCCUR '.. 1 MED EXP(Any one parson) $ 5,00(
<br /> PERSONAL&ADV INJURY $ 2,000,00
<br /> GENERAL AGGREGATE $ 4,000,00
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 4,000,00
<br /> POLICY PRO- F7 LOC $
<br /> AUTOMOBILE LIABILITY ', COMBINED SINGLE LIMIT $ 1,000,00
<br /> (Ea accident)
<br /> A ANY AUTO '.. 1I, BODILY INJURY(Per person) $
<br /> ALL OWNED AUTOS 1
<br /> BODILY X SCHEDULED AUTOS 1Q110131551 1 11/01/2013 11/01 12014 PROPS INJURY(Peraccident) $
<br /> PROPERTY DAMAGE $
<br /> X HIRED AUTOS IQ110131551 1 11/01/2013 11/01/20141 (Per accident)
<br /> X NON-OWNED AUTOS Q110131551 11101/2013111/01/2014 $
<br /> A X Uninsured !Q110131551 11/01/20131 11/01/2014! $
<br /> X I UMBRELLA LIAB X OCCUR ! EACH OCCURRENCE $ 1,000,00
<br /> !
<br /> EXCESS LIAB CLAIMS-MADE'. AGGREGATE $ 1,000,00
<br /> A Q350971221 11/01/2013 11/01/2014 Excludes $
<br /> DEDUCTIBLE
<br /> RETENTION $ Prof Liab $
<br /> WORKERS COMPENSATION X I WCR STATU- OTR-
<br /> AND EMPLOYERS'LIABILITY Y/N TS
<br /> A I ANY PROPRIETOR/PARTNER/EXECUTIVE NIA ;Q950102272 11/O1/2013 11/O1/2014 E.L.EACH ACCIDENT $ 500,000
<br /> OFFICER/MEMBER EXCLUDED?
<br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,00
<br /> If es,describe under
<br /> DESCRIPTION OF OPERATIONS below ' E.L.DISEASE-POLICY LIMIT $ 500,00
<br /> B Professional Liab PGIARK02903-01 06127/2014105/27/2015 iEa Claim 1,000,00
<br /> !Aggregate 2,000,00
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required)
<br /> New Hope Creek Preserve - Hollow Rock Access Area
<br /> Oran a Co. Dept of Environment, Agriculture, Parks & Recreation is an
<br /> additional insured as respects general liability arising from the insured's
<br /> operations.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Orange Co Dept.of Environment ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Agriculture,Parks&Rec
<br /> Attn: Marabeth Carr AUTHORIZED REPRESENTATIVE
<br /> PO Box 8181
<br /> Hillsborough,NC 27278
<br /> 1988-2009 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD
<br />
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