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DocuSign Envelope ID:89F4F543-24CB-4190-A1B9-OB8FC1C5BCBE <br /> LAWRE-1 OP ID: MG <br /> A�0 DATE(MMMD1YYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE 0812512014 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE }FOLDER. 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 INSURERS), 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 ondorsemenl(s). <br /> PRODUCER CONTACT NAME: Gordon Allen <br /> Thompson-Allen,Inc. PHONE 336-599-2175 r No,;336 599-6932 <br /> P.O.Box 100 Arc No Ext <br /> Roxboro,NC 27573 E-MAIL <br /> Marcia D.Green ADDRESS: <br /> INSURER(S)AFFORDING COVERAGE NA[C# <br /> INSURERA-,Cincinnati Insurance Company 10677 <br /> INSURED Tommy Lawrence Electrical INSURERB:Cinrinnatl Casualty Company 28665 <br /> P.O.Box 641 <br /> Roxboro,NC 27573 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 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 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 /> kDDE POLICY EFF POLICY EXP <br /> ILTR TYPE OF INSURANCE INSD POLICY NUMBER IMWDDNYYYl (MMIDD/YYYY1 LIMITS <br /> A X I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 300,00 <br /> CLAIMS-MADE a OCCUR EPP 0096783 08116/2014 08/16/2015 pREMIS�ES ERaEo cu,ante S 100,00 <br /> MED EXP(Any one person) $ 6,00 <br /> PERSONAL&ADVINJURY $ 500,00 <br /> GE N'L AGGREGATE LI MIT APPLIESPER, GENERAL AGGREGATE $ 1,000,00 <br /> POLICY PRO LOC PRODUCTS-COMPIOPAGO $ 1,000,00 <br /> JECr <br /> orHER: <br /> AUTOMOBILE LIABILITY COMBINED a ccidenntSINGLE LIMIT S 1,0 00,00 <br /> A X ANY AUTO EBA 0096783 08/16/2014 08116/2015 BODILY INJURY(Per person) S <br /> ALL OIA VED SCHEDULED BODILY INJURY(Per accident) S <br /> AUTOS NO-0= 4ED PROPERTY DAMAGE S <br /> WRED AUTOS AUTOS Per accident)_ <br /> S <br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,00 <br /> A EXCESS LIAB CLAIMS-MADE EPP 0096783 0811612014 08/16/2015 AGGREGATE s 5,000,00 <br /> DEO RETENTION$ $ <br /> WORKERS COMPENSATION 3TgTUrE EORH <br /> AND EMPLOYERS'LIABILITY <br /> B ANY PROPRIETORIPARTNERIEXECUTIVE Y� C8966267-17 0110112014 0110112015 E.L.EACH ACCIDENT $ 100,00 <br /> OFFICERIMEMBER EXCLUDI NIA <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 100,00 <br /> If yea,descrbe under E,L.DISEASE-POLICY LIMIT $ <br /> 500,00 <br /> DESCRIPTION OF OPERATIONS below <br /> DESCRIPTION OF OPERATIONS i LOCATIONS f VEHICLES(ACORD 161,Additional Remarks Schedule,may be attached if more space Is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> ORANGCG <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Orange County Government THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Parks and Recreation <br /> Lori Taft AUTHORIZED REPRESENTATIVE <br /> 200 South Cameron Street Marcia D.Green <br /> Hillsborough,INC 27278 <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014101) The ACORD name and logo are registered,narks of ACORD <br />