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DocuSign Envelope ID:05D7461F-6E02-485E-BC37-05A109DE2D2B <br /> LAWRE-1 OP ID: MG <br /> CERTIFICATE OF LIABILITY INSURANCE F DATE(MMIDDIMY) <br /> 01119/2015 <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 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 Ileu of such endorsement(s). <br /> PRODUCER NAME: Phillip Allen <br /> Thompson-Allen,Inc. PHONE 336-599-2175 AX No:336-599-6932 <br /> P.0.Box 100 Arc No Exl <br /> Roxboro,INC 27573 EMAIL <br /> Marcia D.Green ADDRESS: <br /> INSURER(S)AFFORDING COVERAGE NAIC q <br /> INSURERA:Cincinnatl Insurance Company 10677 <br /> INSURED Tommy Lawrence Electrical INSURER B.Cincinnati Casualty Company 28665 <br /> Contractor's Inc. <br /> P.O.BOX 641 INSURER C: <br /> Roxboro, NC 27573 INSURERO: <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 /> BR POLICY EFF POLICY EXP <br /> 1LTR TYPE OF INSURANCE p POLICY NUMBER IMMIDDrrm MMlDDIYYYY LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 544,44 <br /> CLAIMS-MADE 0 OCCUR EPP 0096783 08/16/2014 0811612815 PREMISES Eaoccurrenco $ 100,00 <br /> MED EXP(Any one person) $ 5,00 <br /> PERSONAL 4AOVINJURY $ 500,00 <br /> GEN'L AGGREGATE LIM IT APPLIES PER: GENERAL AGGREGATE $ 1,040,4{) <br /> PRO PRODUCTS-COMPlOPAGG $ 1,004,04 <br /> POLICY❑JECT LOC <br /> 5 <br /> OTHER: <br /> AUTOMOBILE LIABILITY C6B� <br /> E0n4dent)_INGLE LIMIT $ 1,444,44 <br /> A X ANY AUTO EBA0096783 08/16/2014 08/1612015 BODILY INJURY(Per person) $ <br /> ALLOIANEO SCHEDULED BODILY INJURY(Per arcideni) $ <br /> AUTOS ON-O <br /> NI tNEO PROPERTY DAMAGE <br /> H R AUTOS $ <br /> Per accident <br /> $ <br /> X UMBRELLALIAB X I OCCUR EACHOCCURRENCE S 5,044,44 <br /> A EXCESSLfA6 CLAIMS-MADE EPP 0096783 0811612014 08!1612095 AGGREGATE S 5,000,04 <br /> DEO I I RETENTIONS _ $ <br /> WORKERS COMPENSATION STATUTE ER" <br /> AND EMPLOYERS' YIN <br /> ITY <br /> B ANY PROPRIETORrPARTNARTNERfFXECUTIVE ❑MIA C8966267-18 01/0112015 01/0112016 E.L.EACH ACCIDENT $ 100,00 <br /> OFFICERWEMBER EXCLUDED? 144,04 <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S <br /> If es,desaibe under E.L.DISEASE-POLICY LIMIT S 500,00 <br /> D SCR)PTION OF OPERATIONS below <br /> DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES (ACORD 901,Additional Remarks Schedute,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 /> 20D South Cameron Street Marcia D,Green <br /> Hillsborough,NC 27278 <br /> O 1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br />