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DocuSign Envelope ID: E7493F65-B5BC-4436-B186-97175E66E627 <br /> �.� OP ID: LH <br /> CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYYI <br /> 05/1312015 <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(les) 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 Phone:919-582-4814 NAME: Debbie Callahan <br /> The Sorg[Insurance Agency Fax:919-682-4906 PHONE E 919-602-4814 aAX No; 919.682.4906 <br /> 16 Consultant Place Suite 102 we No xt <br /> Durham,NC 27707 n DRESS:debbie sorgiinsurance.com <br /> James E.Sorgl,CIC PRODUCER TRIALAN <br /> CUSTOMER ID#: <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURED Triangle Landscaping Inc. INSURERA:Er€e 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 /> ILTR TYPE OF INSURANCE OD B POUCYNUMBER MMfDI�YIYYYY POLICY LIMITS <br /> GENERALLIABILITY EACH OCCURRENCE $ 1,000,00 <br /> X COMMERCIAL GENERAL LIABILITY Q2726204479 03126/2015 03126/2016 PREMISES Ea occurrence) <br /> CLAIMS-MADE L i OCCUR MED EXP{Any one person) S <br /> PERSONAL&ADV INJURY $ 1,000,00 <br /> GENERAL AGGREGATE $ 2,000,00 <br /> GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG S 2,000,00 <br /> POLICY PRO LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 750,00 <br /> (Ea accident) <br /> A ANY AUTO Q032630379 63/2612015 03/26/2016 <br /> BODILY INJURY{PerPerson) S <br /> ALL OWNED AUTOS BODILY INJURY(Per accident) S <br /> X SCHEDULEDAUTOS <br /> PROPERTY DAMAGE $ <br /> HIREDAOTOS (Per accident) <br /> NON-OWNEDAUTOS $ <br /> 5 <br /> UMBRELLALIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIA9 HCLAWS-MADE AGGREGATE $ <br /> DEDUCTIBLE $ <br /> RETENTION S $ <br /> WORKERS COMPENSATION X I WCSTATU- 0TH- <br /> AND EMPLOYERS'LIABILITY TORY LIk41TS ER _ <br /> X ANY PROPRIETORIPARTNERIEXECUTIVE <br /> YIN <br /> F--1 Q872600559 03/2612015 03/26/2016 E.L EACH ACCIDENT S 100,00 <br /> OFFICE RWEMBEREXCWDED? NIA <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 100,00 <br /> If es,describe under <br /> D SCRIPTIONOFOPERATIONSbelow E.L.DISEASE-POLICY LIMIT $ 500,00 <br /> A Contractors equip 0272620479 0312612015 03125/2016 Equipment 92,30 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES(Attach ACORD 101,Addlllonat Remarks Schedule,If more space Is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Orange County Parks & 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 ' ✓ <br /> O 1988-2009 ACORD CORPORATION. All rights reserved. <br /> ACORD 26(2009109) The ACORD name and logo are registered marks of ACORD <br />