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DocuSign Envelope ID:OA6FEBA7-7CB5-4523-A4D2-2089COOE5340 <br /> A oRO® CERTIFICATE OF LIABILITY INSURANCE 06/0 /2IDDIYYYY) <br /> 06!09/2015 <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 CON NA ME:TACT <br /> BB&T INSURANCE SERVICES INC AICNNo,Ert: see 6613938 FpC No: (888)672-8921 <br /> 414 GALLIMORE DAIRY RD STE F E-MAIL <br /> GREENSBORO,NC 27409 ADDRESS: Serviee-cente travelers.com <br /> (888)661-3938 INSURER($)AFFORDING COVERAGE NAIC# <br /> INSURER A:FARMINGTON CASUALTY COMPANY <br /> INSURED INSURER 5: <br /> INFORMATION INC <br /> PO BOX 1306 INSURER C: <br /> CARRSORO,NC 27510 INSURER D: <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 736973104531061 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 ADD SUBR POLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE INSDI WVD POLICY NUMBER MMIODIYYYY MMfDDryYYY LIMITS <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ <br /> A A E TO RENTED <br /> CLAIMS-MADE OCCUR PR M Ea occurrence $ <br /> MED EXP(Any one person) $ <br /> PERSONAL&ADV INJURY $ <br /> GFN'L AGGRI=GATE LIMIT APPLIES PER: GENERAL AGGREGATE $ <br /> POLICY PRO 7LOC <br /> JECT PRODUCTS-COMPIOPAGG $ <br /> OTHER: $ <br /> COMBINED SINGLE LIMIT $ <br /> AUTOMOBILE LIABILITY (a accident) <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED <br /> AUTOS AUTOS BODILY INJURY(Peraccident) $ <br /> HIRED AUTOS NON-OWNED <br /> AUTOS (PerracGd accident)DAMAGE $ <br /> $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE <br /> AGGREGATE $ <br /> DED RETENTION$ <br /> A WORKERS COMPENSATION NIA UB-OF330489-14 0$/27/2014 08/27/2015 X PER OTH <br /> AND EMPLOYERS'LIABILITY Y!N <br /> ANY PROPRIETORIPARTNERIEXECJTIVE ❑ E.L.EACH ACCIDENT $100,000 <br /> OFFICERIMEMBER EXCLUDED? <br /> (Mandatory In NH) E -DISEASE-EA EMPLOYEE $100,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may he attached If more space Is requiredl <br /> CERTIFICATE HOLDER CANCELLATION <br /> ORANGE COUNTY DSS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> 113 MAYO STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> HILLSBORO.NC 27278 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE 40 1 � <br /> ©1988-2014 ACORD CORPORATION.All rights reserved. <br /> ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />