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DocuSign Envelope ID:679E9844-93E2-4AD7-AOBO-8D34446CA50C <br /> OP ID: LH <br /> ,4co►z°A CERTIFICATE OF LIABILITY INSURANCE naTE113/2 Y5 <br /> o5r73r2a75 <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 13Y THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURE R(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 endorsoment(s). <br /> PRODUCER Phone: 919-682-4814 CONTACT Debbie Callahan <br /> The Sorgi Insurance Agency Fax: 919-682-49x6 PHGNE 918.682-4814 ac No: <br /> 16 Consultant Place Suite 102 Arc No E t: 919.582-4906 <br /> Durham,NC 27707 E-MAIL ESS:debble@sorglinsurance.com <br /> James E,Sergi,CIC PRODUCER TRIALAN <br /> CUSTOMER ID#: <br /> INSURER(S)AFFORDING COVERAGE NAIC A <br /> INSURED Triangle Landscaping Inc. INSURER A;Erta Insurance Exchange 26271 <br /> Brad Lewis dba INSURER B: <br /> 3582 Fletchers Way <br /> Stem, NC 27581 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 /> IN SCR DD POLICY EFF POLICY EXP LIMITS <br /> TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMJDDIYYYY <br /> GENERAL LIABILITY EACH OCCURRENCE S 1,000,00 <br /> X COMMERCIAL GENERAL LIABILITY Q2726204479 0312612016 03/2612016 PREMlsf5 Eaoccurrenco 3 <br /> CLAIMS-MADE I I OCCUR MED EXP(Anyone person) S <br /> PERSONAL&ADV INJURY $ 1,000,00 <br /> GENERALAGGREGATE $ 2,000,00 <br /> GFNLAGGREGATELIMITAPPLIESPER: PRODUCTS-COMPIOPAGG 5 2,000,00 <br /> POLICY n PRO LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SiNGLELIMIT S 750,00 <br /> 0312612015 03/2612016 (Ea accident) <br /> A ANY AUTO Qa32630379 BODILY INJURY(Per person) $ <br /> ALLOWNEDAUTOS BODILY WJURY(Per accident) $ <br /> X SCHEDULEDAUTOS PROPERTY DAMAGE <br /> HIREDAUTOS (Peraccldenl) S <br /> NON-OWNED AUTOS S <br /> 5 <br /> UMBRELLALIAB OCCUR EACH OCCURRENCE S _ <br /> EXCESSLIAB CLAIMS-MADE AGGREGATE $ <br /> DEDUCTIBLE S <br /> RETENTION S $ <br /> WORKERS COMPENSATION X WCSTATU- OTH- <br /> AND EMPLOYERS'LIABILITY TORY ll ER <br /> X ANY PROPRiETORIPARTNERIrXECUTTVEY NIA Q872600559 03/26/2015 03/2612016 E.L.EACH ACCIDENT $ 100,00 <br /> OFFICERIMEMSER EXCLUDED? <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,00 <br /> Ifyes,desuibe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 <br /> A Contractor's equip Q272620479 03!2612015 03/26/2016 Equipment 92,30 I T- 1 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES (Attaett ACORD 101,Additional Remarks Schedule,it more space Is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Orange County Parks Pk & THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Recreation <br /> Lori Taft AUTHORIZED REPRESENTATIVE <br /> PO Box 8181 <br /> Hillsborough,NC 27278 ;u. f <br /> ©1988-2009 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD <br />