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'� `Efrie CERTIFICATE OF INSURANCE DATE ISSUED( MroDinn <br /> insurance —THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY— <br /> Home Office • 100 Erie insurance Place • Ede,Pennsylvania 16530 • 814.87C 2000 <br /> Toll free 1.800.458.0811 • Fax 814.870.3126 •www.erleinsurance,com <br /> NAME AND ADDRESS OE ACEMY THE BALLARD AGENCY INC AGWS NO. AF <br /> 105 W KING ST 171010 <br /> HILLSBOROUGH,NC 27278-2543 Co.,E 1:114 "! No Applicable) <br /> Indasuti me- <br /> (919)732-2158 This certificate Is Wiled for information purposes onf9y and confers <br /> NAME AND ADDRESS DE NAMED INSURED no rights of the certificate belft it dose not offfrmativei of <br /> nertively amend,extend,or otherwise aih ens <br /> r The terms,ezch<si <br /> HISTORICAL FOUNDATION OF and conditions of insurance coverage coahllned in the policy(ies) <br /> HILLSBOROUGH&ORANGE CO indicaMd below.The farms and eeadltieas of tite pitcy{fas)govarn <br /> a Insurance coverage as aa9Nad to any given sitaattfln.Umth <br /> 201',N'.CHURTON ST. sbewra may have been rodaaed by elates:paid.This certificate of <br /> Insurance does ad constitute a contract between the issuing <br /> HILLSBOROUGH,NC 27278 Insurer(s),authorized representative or producer and the <br /> Certificate holder. <br /> This Is to ce that policies,as Indicated by the Policy Number below,are In force for the Named Insureciadt the time tirat the Certificate is being issued. <br /> itlf P gal —- <br /> LIMITS <br /> E GIENSIAL LIABIRM EAMOCCUWNCE:,i 1 000 000 <br /> COL9tAERCIAIGENERAIUANLRY Q44 2250193 8122113 8122714 • ---_•0 <br /> FI'liEftAiblAlfE�� 1 000 000 <br /> ❑ctAw MADE ®occuni fte S 5 000 <br /> o I 1,900 0DO <br /> "I OT�itALA66 2 000 000 <br /> GEN'L AGGREGATE DMITAPPUES PEA!! PROD0GTS=COAI MPA86 S 2,000,000 <br /> POUGY ❑PROJECT []LOG' <br /> AUfOUMLE LIABILITY <br /> E <br /> OWNED i $O1T> fi s <br /> El Rife $ <br /> NON-OWNED >$ODIL dtNf3 <br /> ❑GWGE D S <br /> E7XM LIABILITY <br /> ❑OtxURREIICE N TE S <br /> S <br /> itEfENTiDN 8 IS J <br /> F i WORKERS COASIVISAT1011& <br /> EMPLOYERS LIABILITY � Q92 2200215 8/22113 8!22114 ACCIDENT 5 100,000 EACH ACCIDENT <br /> ILY <br /> DISEASE S 500,000 Poucvuni <br /> BY DISEASE $ 100,000 TACHEMPLOYEE <br /> OTHR <br /> DESCRIPTION OF OPERATIDNWLOCA ICLESIO(CLUSTONS ADDED BY ENDORSEMt3R/SPECIAL PROVISIONS <br /> CANCELLATION: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIV- <br /> ERED IN ACCORDANCE WITH THE POLICY PROVISIONS. <br /> IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the poliicy(jes)must be endorsed.If SUBROGATION IS WAIVED,subject to the <br /> terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer <br /> rights to the certificate holder In lieu of such endorsement(s). <br /> NAME AND ADDRESS OF CERT11FICA7E HOLDER <br /> ORANGE COUNTY GOVERNMENT AunaRME1121RESENrATK <br /> PO BOX 8181 <br /> HILLSBOROUGH,NC 27278 <br /> EIGW30 8/11 <br /> Page 1 of i <br />