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DocuSign Envelope ID: 9141986F-1B82-40FD-B364-5C818EB0DBD6 *�.��DATE(MMIDDIY Y'fl
<br /> ACORP, GER-1 IF IUA I t Ut- UABILITY INSURANCE 0
<br /> 0 6 12 5�1�2'10 15
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONIFERS 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 CONSTIITUTE A CONTRACT BETWEEN THE ISSUIING INSURER(S),AUTHORIZED
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> ED,the poficy(ies)must be endcarsed. If SIUBRO ATION IS WAIVED,SUbject to
<br /> the terms and condifions of the poficy, certalin policies may require an endiorsernent. A statement On this certificate does not confer rights to the
<br /> certificate ho der In lieu of such endorsement(s)�
<br /> PRODUCER NAME:
<br /> ---- ...........
<br /> PHONE
<br /> Henry A Latimer & Son Inc 301.229.1500 "'(04 Noi:31101.3210111.112458
<br /> 'M IL
<br /> 4701 Sangamore Rd. Suite 5-250 ADDRESS. ...........
<br /> Bethesda, MD 20816 INSURER(S)AFFORDING COVERAGE, NAlC#
<br /> INSURER A: lErie Insurance Company 26211163
<br /> 262 71
<br /> WSUREG Tischler-Mse: INSURER 8:' Erie Insurance--Ex-chalri,ge
<br /> 4701 Sangamore Rd INSURER C: Erie Insurance Property Casual
<br /> Suite 5240 IIINSURER D Travelers Indennility 'Co
<br /> Rethesda, MD 20816 lINSURER E
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: Orange County III REVISION NU:MiBEIR:
<br /> THIS IS TO CERTIFY THAT THE PO ICI:ES OF INSURAN., LISTED BELOW HAVE SEEN ISSUED 10-FFFF:7NSLJRED NAMED—ABOVE FOR THE[53LIcT-P7-IR—K)D
<br /> INDICATED, NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITI10N OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICHITHIS
<br /> CE R1 IFICAT E MAY BIE ISSUIED OR MAY PERT AINI, THE INSURANCE.AFFORDED,BY THE POLNCIES DESCRIBED HER EIN IS SUBJECT TO ALL TV 8L TERMS,
<br /> EXCLUSiONS AND CONDITIONS OF SUCH POUCIES.1AMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
<br /> l NSA" 'ADDLsUSR- U M SER POLICY'I EFr POLICY EXP LIMITS
<br /> TYPE OF INSURANCE INSR V1JrVD POLICY N (MMIR-01—yY
<br /> LTR ----�Q
<br /> Q970,14364&0610,112015 06/011210,16 EACH OCCURRENCE S 1,000,0100
<br /> GENERAL ETt6I DAMAGC70"RENTED
<br /> X Q,OMMERCIA�.GENERA,L.IABJLI'I-Y PREMISES(Ea 1,000,000
<br /> CLAIMS-IMAIDE, 1 11 X .:CUR ME D EXP(Any inle pbr n 5,000
<br /> A X PERSONAL D ADV IINJURY $ 290009000
<br /> GENERAL AGGREGATE $ 2,000,000
<br /> -P RvJLC6S-COMPt)P AGG $ 21000,000
<br /> GEN'LAI33GRIEGATE I 11AIT APPLIES PER
<br /> PRO- $
<br /> P Icy CT
<br /> ol EEL-
<br /> 4 �Ea acciden��
<br /> AUTOMOBILE LIABILITY Q970 14364g�/M1201'606101 1i 1,000
<br /> BODILY INJUIRY(Per person) $
<br /> ANY ALI l 0
<br /> A L OWNED SCHEDULED B0r)fl,Y INJLRY(Per acodeNi
<br /> A AU�CS. AUTO's X PR0rYr--RTY-DAMAC7
<br /> X NON-OWNED $
<br /> X 411IRF D AU B OS AU ros
<br /> /2015 06101126ii EACH OCC�;RRENCE 1,000,000
<br /> �UM 8 R EL C OCCUR Q30017154 ...... ............
<br /> CLAIMS-MADE X
<br /> A EXCESS LIAB AGGREGA T E r 11000,000
<br /> lrroFn RETENTION .77 $
<br /> 54 7-11
<br /> Q90 S 1009 16 061011201 6101/2016 X —
<br /> �ORKERS�C&ii7FEWi-A-7om0N I ORY I II _ER . ........
<br /> AND EMPLOYERS'LIAMLITY Y N
<br /> ANY PROPRIETORMARr FNER)EXECUTIVE - I E I. EAClrli ACCiDE N1jr S 1,000,000
<br /> CIEWPAEM8ER EX(',LUDED'� RRA
<br /> )�Ft E L DISEASE EA EMPt OYEE $ 11000,000
<br /> (Man�dato�rV in NH)
<br /> If y" describe i.inder
<br /> L�ESCR PrIO,INOF�DF"ERA'rliONS,F,ek)w EL DISEASE-POLlCYLIMP $ 1,0,00,0,001
<br /> o—fe s s i-6IIiall�L Ta hl'i—ty
<br /> D Claims made 105 78 3 307 0612812015 1 051282016 $1,000,000
<br /> DESCRIPTION OF OPERA*UON:S I LOCATIONS o VEHICLES IAtfach,ACORD 1101,Additional Remar*sSchodulo,1 more space is required)
<br /> )range County, North Carolina is add,i:ltional insured.
<br /> ,CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPlRATsON DATE THEREOF,NOTICE WILL BE DELIVERED IIN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Orange County (NQ
<br /> kAUTMoR ZED REPRESENTATIVE
<br /> Planning Department
<br /> P.O. Box 8181 *100
<br /> Hillis borough, NC 27278 Richard Lavtte�e 61 1
<br /> '1988-2010 ACORD CORPORATION. All rights reserved.
<br /> ACORD 2 5(2010105), The ACORD name and logo are registered marks of ACORD
<br />
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