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DocuSign Envelope ID:08F45309-8OC9-43F8-8726-355DC9530CD8 <br /> OP ID: DS <br /> OATE(MMIE70fYYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE F 09/09/2015 <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 Ileu of such ondorsemenl(s). <br /> CONTACT <br /> PRODUCER NAME: <br /> Hig Arc h&Rubish Insurance Agency PHONE <br /> P.O.Box 3040 No Exl: FAX No <br /> 6015 Farrington Rd.Ste 101 ADDRESS: <br /> Chapel Hill,NC 27517 PRODUCER TIt L E-1 <br /> Jeffrey A.Rubish CUSTOM ERID,; <br /> ENSURER(S)AFFORDING COVERAGE NAtC 11 <br /> INsuREo Greg Tilley's Pressure INSURER A:Erie insurance Exchange 26271 <br /> Cleaning,Gregory Tilley DIBIA INSURERS: <br /> 3600 Hwy 54 West <br /> Chapel Hill,NC 27516 INSURER <br /> INSURER 0 D <br /> 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 /> gR POLICY EFF POLICY EXP <br /> ILTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMIDDfYYYY LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE S 1,000,00 <br /> A X COh4MERCIAL GENF=RAL LIA8IDTY Q38W50572 02117/2015 02117/2016 PREMISES�Errence) S 1,000'00 <br /> CLAIMS-MADE [K OCCUR �MED EXP(Any one person) 5 5,00 <br /> PERSONAL&ADViNJURY $ 1,000,00 <br /> G£NERALAGGREGATE $ 2,000,00 <br /> GEN'L AGGREGATE LIMIT APPLIESPER: PRODUCTS-COMPlOPAGG $ 2,000,00 <br /> POLICY PRO- LOC $JECT <br /> AUTOMOBILE LIABILITY Ea aco <br /> TY ED SINGLELIMl7 S 1,000,00 <br /> Q102740041 10/27/2014 10/27/2015 {Ea CG dent) <br /> A X ANY AUTO BODILY INJURY(Per person) $ <br /> ALL O1ANED AUTOS BODILY INJURY(Per accddenl) $ <br /> SCHEDULED AUTOS PROPERTY DAMAGE $ <br /> X HIREOAUTOS (PER ACCIDENT) <br /> X NON-O NFO AUTOS $ - <br /> $ <br /> UMBRELLA LIAR X OCCUR EACHOCCURR£NCE S 1,000,00 <br /> A <br /> X EXCESS LtAB CLAIMS-MADE Q261770167 02117/2015 02117/2016 AGGREGATE S 1,000,00 <br /> DEDUCTIBLE $ <br /> RETENTION S S <br /> WORKERS COMPENSATION X ORSTATU- (J R <br /> AND EMPLOYERS'LIABILITY T RY LIMITS ER <br /> A ANY PROPRIETORIPARTNERfFXECUrIVEY� NIA <br /> Q861700463 02117/2015 02117/2016 F.L.EACH ACCIDENT $ 500,00 <br /> OFHrER,MEMBER EXCLUD£D7 500,00 <br /> (Mandatory In NH) E_L_DISEASE-EA EMPLOYE $ <br /> it yes,describe under EL DISEASE-POLICY LIMIT $ 500,00 <br /> DESCRIPTION OF OPERATIONS below <br /> DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If moro space Is required) <br /> II <br /> CERTIFICATE HOLDER CANCELLATION <br /> ORANG-3 <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Orange County ACCORDANCE WITH THE POLICY PROVISIONS. <br /> P.O. Box 8181 <br /> Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE <br /> ©1988-2009 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD <br />