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DocuSign Envelope ID: D853F7DC-B7BD-45C2-8896-04A94OB50FE4 <br /> LAWRR-1 OP ID: MG <br /> .4coR° CERTIFICATE OF LIABILITY INSURANCE DATE I <br /> 01!1191219124115 5 <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($), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(fes) 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 Ifou of such endorsement(s). <br /> PRODUCER CONTACT Phillip Allen <br /> Thompson-Allen,Inc. PHONE FAx <br /> P.O.Box 100 Arc Nu Ext:336-599-2175 ArC Ne;336-599-6932 <br /> Roxboro,INC 27573 E-MAIL <br /> Marcia D.Green ADDRESS: <br /> INSURER(S)AFFORDING COVERAGE NAIC 9 <br /> INSURER A:Cincinnati Insurance Company 10677 <br /> INSURED Tommy Lawrence Electrical INSURER 13:Cincinnati Casualty Company 28665 <br /> Contractor's Inc. <br /> P.O. Box 641 INSURER C: <br /> Roxboro,NC 27573 INSURERD: <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 /> 1LTR TYPE OF INSURANCE IN p 0 POLICY NUMBER MWDD� MMI�DPCfYY LIMITS <br /> A X COMMERCIALGENERALLIABILITY EACH OCCURRENCE $ 500,00 <br /> CLAIMS-MADE a OCCUR EPP 0096763 0$11612014 08/16/2015 PREMISES Ea occurrence $ 100,00 <br /> MED FXP(Any one person) S 5,00 <br /> PERSONAL&ADV INJURY S 5()0,00 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 1,000,0() <br /> POLICY JE° ❑LOC PRODUCTS-COMPIOPAGG $ 1,()00,00 <br /> OTHER: S <br /> AUTOMOBILE LIABILITY COMBINFO SINGLE LIMIT g 1 00000 <br /> Ea accident r <br /> A X ANY AUTO EBA0096783 08116/2014 0811612015 BODILY INJURY(Per person) $ <br /> ALL 0A 4FD SCHEDULE(] <br /> AUTOS AUTOS BODILY INJURY(Per accident) $ <br /> HIRED AUTOS NON-OVVNED RTY PROPE DAMAGE S <br /> AUTOS Per acc dent <br /> S <br /> X UMBRELLA LIAO X OCCUR EACHOCCURRENCE $ 5,000,00 <br /> A EXCESS LIAO CLAIMS-MADE EPP 0096783 0$11612014 08H612015 AGGREGATE S 5,000,00 <br /> DED I I RETENTIONS $ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY STATUTE ER <br /> B ANY PROPRIETORlPARTNERIEXECUTiVE YtN C8966267.18 01/01/2015 01/01/2016 E.L.EACH ACCIDENT $ 100,00 <br /> OFFICERVEMBER EXCLUDED? El NIA <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEq$ 100,00 <br /> If yyes,describe Undef <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 500,00 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES (ACORD 101,AddRIonal 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 /> Oran a County Government THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Parks and Recreation <br /> Lori Taft <br /> 200 South Cameron Street AUTHORIZED REPRESENTATIVE <br /> Marcia D.Green <br /> Hillsborough, NC 27278 <br /> ©1986-2014 ACORD CORPORATION, All rights reserved. <br /> ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD <br />