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DocuSign Envelope ID: E42A16D1-4ECA-4D4C-B1E0-D3FFDA69010B <br /> MULBE-1 OP ID: NE <br /> DATE(MM/DD/YYYY) <br /> �.. , CERTIFICATE OF LIABILITY INSURANCE 1 07/22/2015 <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 CONTACT <br /> High&Rubish Insurance Agency PHONE FAx <br /> P.O.Box 3040 WC,No Ext: AIC No <br /> 6015 Farrington Rd.Ste 101 E-MAIL <br /> Chapel Hill,NC 27517 ADDRESS: <br /> Christopher Ives Rubish INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURERA:Erie Insurance Exchange 26271 <br /> INSURED Mulberry Building Co.,LLC INSURER B: <br /> &Mulberry Restoration Inc. <br /> Peter Yeganian INSURER c <br /> 9501 HWY 86 N INSURER D: <br /> Cedar Grove,NC 27231 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 /> INSR DDL UBR POLICY EFF POLICY EXP LIMITS <br /> LTR TYPE OF INSURANCE POLICY NUMBER MM/DWYYYY MM/DD/YYYY <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> • X COMMERCIAL GENERAL LIABILITY Q38-0153893 02/01/2015 02/01/2016 DAMAGE T RENT D 1,000,000 <br /> PREMISES Ea occurrence $ <br /> CLAIMS-MADE LA J OCCUR MED EXP(Any one person) $ S,UU <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GENERAL AGGREGATE $ 2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> POLICY JE0 LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 <br /> Ea accident $ <br /> • X ANY AUTO Q02-0132026 02/01/2015 02/01/2016 BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> NON-OWNED PER ACCIDENT DAMAGE $ <br /> HIREDAUTOS AUTOS <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAR CLAIMS-MADE AGGREGATE $ <br /> DED I I RETENTION$ $ <br /> WORKERS COMPENSATION WC STATU- OTH- <br /> AND EMPLOYERS'LIABILITY X TORY LIMITS ER <br /> • ANY PROPRIETOR/PARTNER/EXECUTIVE YNIA Q86-0600694 0210612015 02106/2016 E.L.EACH ACCIDENT $ 100,000 <br /> OFFICER/MEMBER EXCLUDED? <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) <br /> email to: psandbeck @orangecountync.gov <br /> CERTIFICATE HOLDER CANCELLATION <br /> ORANGEC <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> ORANGE COUNTY DEAPR THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> P O BOX 8181 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 306-A REVERE RD. <br /> HILLSBOROUGH, NC 27278 AUTHORIZED REPRESENTATIVE <br /> ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD <br />