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DocuSign Envelope ID: FEB529CO-9949-408E-BA70-88A22C3EE071
<br /> 0
<br /> [:!05/19/2015 TE(MMIODIYYYY)
<br /> �+► +�►Rt CERTIFICATE OF LIABILITY INSUI INSURANCE
<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 DOTES 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 dues not confer rights to the
<br /> certificate holder In lieu of such endorsement(s),
<br /> PRODUCER CONTACT
<br /> NAME; Joshua E Matthews
<br /> Joshua E.Matthews Insurance Agency Inc. _[Aa�Na,.Ex (,919)598-6800 °o
<br /> 2144 Page Rd.Suite 108 E-MAIL
<br /> ADDRESS.. Josua J h rruatthewsinsurance.com
<br /> INSURERS. AFFORDING COVERAGE 1 .....NAIC#
<br /> . . ..... L.1.._.INSURER A ERIE INS EXCH 26271
<br /> INSURED ... ...NC 277p3 ENSURER a ........ . ........ ..... .
<br /> CAROLINA EARTHSCAPES INC INSURER
<br /> P.O.BOX 77 INSURER D:
<br /> INSURER.
<br /> Butner NC 27509-0077 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 /> mo ---...---..... . .... ............Aubl—:;SU'§F.j ...,.,.... .. ... „ ......,._... ...„...tsQ�ICY EFF -POLICY EkP 1 ............. ......,_._,,.. ...... .. ....
<br /> LTIR TYPE OF INSURANCE I POLICY NUMBER MMtDDPYYYY MMIDDNYYY LIMITS
<br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> .. _
<br /> CLAIMS-MInDE �ccCUR PuwuS(Eao—rrencc $ 1,00000O
<br /> ............... ... ........ ......_,. M.dCIE.XPFAr onepernon) S 5.000 ,.
<br /> A Q28.1121458 04/1112015 04/111/2016 PERSONAL&ADEIIN,IURY $ 1,000,000
<br /> G.ENL AGGREGATE LIM'�.lTAP'PLIES PER GIENEN.AGGREGATE. s 2,000,000
<br /> 1
<br /> POLICY LOO PRCr UCT atPF aT1E,� t 2,000,000
<br /> AUTOMOBILE LIABILITY 1 COMBINED SINGLE LIMIT � ..
<br /> ANY AUTO BODILY INJUIRY(Per personl 5
<br /> ALL DVVNED F SCHEDUL.ErD
<br /> Ad.ITL"S AUTOS BODILY INJI,IRR'Y(Per a=deni) �
<br /> NON-OWNED PRC PER fY DAMAi",E
<br /> HIRED AUTOS
<br /> AUTOS .I~Pe�e aor��I�I�I➢....
<br /> I s
<br /> i UMBRELLA LIMB Iy OCCUR EA6wlI CM,FG"E,IRREfiOGF $
<br /> 1 EXCESS LIAR 1 w •. _ .. .. ..
<br /> I:::LAIMS-MADE( � �A�GREG,A'FE.. ............. t.. ., ,.. .........,.... ....
<br /> DEC FI'..ETF.NTICNS 5
<br /> IMYORKIERSCOMPENSATION I PER fil{
<br /> ANY PR'9PRIETORNPARTNi '�TATAC FR„
<br /> AND EMRr'Lt"JYERS'LIABIL Y F N ----
<br /> "WFICEa In ,N1A', EF--E tHAGCTYENT .........— re
<br /> t;1FeICFi+I.fMEMufiBEP EXCLUDED?
<br /> .. ....... _
<br /> I I E L.ETU /"ASE-F.A EMPLOYE a S
<br /> t nqs,describe under I ......_.
<br /> €7ESCRIPTION OF OPERATIONS below I E L.DISEASE.POLICY LIMIT S
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more spa"is required)
<br /> CERTIFICATE HOLDER, CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE 'WILL BE DELIVERED IN
<br /> Change County ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 200 S,Cameron St
<br /> AUTHORIZED REPRESENTATIVE
<br /> Hillsborough NC 27278 :,.
<br /> 1988W2014 ACORD CORPORATION,All rights reserved.
<br /> ACCORD 25(2014101) The ACORD name and logo are registered'marks of ACORD
<br />
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