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CERTIFICATE OF LIABILITY INSURANCE DATE(MAA/DDVYYI/Y) <br /> 01/23/2015 <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 NAME Sharon English <br /> ASHBY INSURANCE AGENCY PHONE 919-732-1052 FAX' teFE-MAIL 919 732-1574 <br /> ac No <br /> arm 206 Millstone Drive DD ES:sharon.english.ae27 @statefarm.com <br /> Hillsborough, NC 27278 <br /> INSURERS AFFORDING COVERAGE NAIL# <br /> INSURER A:State Farm Fire and Casualty Company 25143 <br /> INSURED Paul Stanley Pittman INSURER B: <br /> 4506 Harmony Church Rd INSURERC: <br /> Efland, NC 27243 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 /> INSR Ama UB MPOMIDDA"rF MAUDLIDIYYY LIMITS <br /> LTR TYPE OF INSURANCE POLICY NUMBER <br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> CLAIMS-MADE ❑❑OCCUR 93-BX-N761-5 08/0512014 08/052015 PREMISES Ea occurrence) $ <br /> MED EXP(Any one person) $ 5,000 <br /> PERSONAL&ADV INJURY $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GE NERAL AGGREGATE $ 2,000,000 <br /> POLICY❑PRO- F-1 JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> Ea accident <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED <br /> AUTOS AUTOS BODILY INJURY(Per accident) $ <br /> HIREDAUTOS NON-OWNED PROPERTY DAMAGE $AUTOS f —$_ <br /> Per accident <br /> UMBRELLA LIAR OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAR CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION ER OTH- <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? NIA <br /> (Mandatory In NH) <br /> If E.L.DISEASE-EA EMPLOYE $ <br /> yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 $ <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 CANCELLED BEFORE <br /> PO BOX 201 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Hillsborough, NC 27278 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTNO PRESENTATIVE <br /> 461988-20i AC CORPORATION.All rights reserved. <br /> ACORD 25(2014101) The ACORD name and logo are registered marks of ACO 1001486 132849.9 02-04-2014 <br />