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® DATE(MM/.')'1-,,1y,,.. <br /> ACORL7 CERTIFICATE OF LIABILITY INSURANCE 1/2/201.4 <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 pollcy(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(a), _ <br /> PRODUCER NAME: J. DAVID BALLARD <br /> BALLARD AGENCY INC PHONE C N EXI: (919)732-2158 ac No):(919)732-9636 <br /> PO Box 1559 rf ADDRESs:ballard @ballarda encyinc.com <br /> Hillsborough, NC. 27278 INSURER(S) AFFORDING COVERAGE onlce <br /> INSURER A:VOLUNTEER SAFETY WORKERS COMPENSATION FUND <br /> INSURED ORANGE RURAL EIRE DEPARTMENT #1, INC. INSURER B: <br /> PO BOX 1511 INSURER C: <br /> HILLSBOROUGH, NC 27278 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 BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY f'I:;10D <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH l IIII, <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR R POLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE INSO VIVO POLICY NUMBER MWDD/YYYY MMIDD/YYYY LIMITS --`_ <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ _ <br /> DOMotz IV KEN It' <br /> CLAIMS-MADE FI OCCUR PREMISES Ea occurrence $ <br /> MED EXP(Any one person) $ <br /> PERSONAL&ADV INJURY $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ <br /> POLICY F—]PRO- F7 LOC PRODUCTS-COMP/OP AGG $ - <br /> JECT <br /> OTHER: ---- <br /> AUTOMOBILE LIABILITY Ea accident $ <br /> ANYAUTO BODILY INJURY(Per person) $ _ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS —- <br /> HIRED AUTOS AUTOSWNED Per accident $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAR HCLAIMS-MADE AGGREGATE $ <br /> DED I I RETENTION$ $ — <br /> WORKERS COMPENSATION X STATUTE ER _ <br /> AND EMPLOYERS'LIABILITY YIN <br /> ANY PROPRIETORIPARTNER/EXECUTIVE 911—710-0 7/1/13 7/1/14 E.L.EACH ACCIDENT $ 100 r 000 <br /> A OFFICER/MEMBER EXCLUDED? 2:1 NIA <br /> (mandatory In NH) E.L.DISEASE-EA EMPLOYE $ �.(�O ,000 <br /> Ryyes desu 0 ibeuntler rr <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> ORANGE COUNTY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEt I ED 13EFORE <br /> PO BOX 8181 THE EXPIRATION DATE THEREOF, NOTICE WILL BE OLIVE RED IN <br /> HILLSBOROUGH, NC 27275 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUT IZED REPRESENTATIVE V <br /> ©1988-2013 ACORD CORPORATION. All rights reserved. <br /> ACORD25(2013/04) The ACORD name and logo are r gistered marks of ACORD <br />