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DocuSign Envelope ID:41A7B1F9-5095-475D-BEDD-BA78B97467EF LIABILITY INSURANCE ACORD DATE(MMaonrYYYY) <br /> sM 7/09/15 <br /> PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> Crismond Insurance Group, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> 8470 Falls of Neuse Road,Suite 206 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Raleigh,NC 27615 <br /> (919)870-1120 j INSURERS AFFORDING COVERAGE NAIC# <br /> INSURED INSUI RRa_Erie Insurance Exchange ...... <br /> Hansell Painting LLC ;INSURER B: <br /> 217 Pineview Road i INSURER C: <br /> Durham,NC 27707 __.__........._ <br /> INSURER D: <br /> I INSURER E: <br /> COVERAGES <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING <br /> ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br /> MAY PERTAIN;THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH <br /> POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLA€MS, <br /> INSR RDD`L --...__.........................-_-- POLICY NUMBER --- POLICY EFFECTIVE POLICY EE�XPIRATION LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> ? Q37 0157277 01101/2015 01/01/2016 <br /> —! AMAu tQ __. <br /> I X COMMERCIAL GENERAL LIABILITY i PREMISES Eaoccurance $ 1,000,000 <br /> _._..._ <br /> A <br /> CLAIMS MADE OCCUR ! i MED EXP(Any.one person) .$__5,000 <br /> j <br /> PERSONAL&ADV INJURY $ 1,000,400 <br /> GENERAL AGGREGATE i$ 2,000.000 <br /> �-� ................................................I.............. <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG 1 $ 2,000,000 <br /> PRO- HOC <br /> POLICY - <br /> i <br /> AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT $ 1,000,000 <br /> X ANY AUTO Q01 0141456 101,101,12015 01/01/2016 (Ea accident) <br /> ALL OWNED AUTOS <br /> ---i j BODILY INJURY $ <br /> A SCHEDULED AUTOS (Per person, <br /> HIREDAUTOS ( �� <br /> BODILY INJURY $ <br /> )C NON-OWNED AUTOS (Per accident) <br /> _. ___................................._-- PROPERTY DAMAGE <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY-EA.ACCIDENT $ <br /> ANY AUTO OTHER THAN EA ACC:5 <br /> AUTO ONLY: AGG $ <br /> EXCESS,UMBRELLA LIABILITY EACH OCCURRENCE $ 2 000 000 <br /> Q25 0174267 01/0112015 0110112016 <br /> OCCUR CLAIMS MADE AGGREGATE 1 s 2,000,000 <br /> A <br /> L� i $ <br /> I DEDUCTIBLE I$ <br /> RETENTION $0 $ <br /> f WC STATU- OTH- <br /> WORKERS COMPENSATION AND Y RY f_1MITS __ <br /> A EMPLOYERS'LIABILITY Q855103164 01/01/15 01/01/16 iE.L.EACH ACCIDENT <br /> $ 1,000,000 <br /> ANY PROPRIETORIPARTNERIEXECUTIVE I ----- <br /> OFF€CERIMEMBER EXCLUDED?Yes E.L.DISEASE-EA EMPLOYE $ 1,000,000 <br /> If yes,describe under .._..._.__....____._. <br /> SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 <br /> OTHER <br /> i <br /> DESCRIPTION OF OPERATIONS i LOCATIONS t VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT t SPECIAL PROVISIONS <br /> Contractors Enhancement Endorsement&Property Damage Liability Deductible-$500 <br /> The following Members are excluded from coverage under Workers Compensation: Philip R.Hansen&Harriet N. Hansell <br /> Insured"s Classifications: Painting <br /> CERTIFICATE HOLDER CANCELLATION <br /> Grange County DEAPR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> PO Box 8181 DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN <br /> Hillsborough, NC 27278 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL <br /> IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR <br /> REPRESENTATIVES. <br /> AUTHORIZED REPRESENTATIVE —I �- <br /> ' „') <br /> ACORD 25(2001108) A ORD C6RP&ATION 1988 <br />