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DocuSiqn Envelope ID: 3A6lC21D-8335-4lC3-A89C-B80BEE158E1D ........ <br /> Erie CERTIFICATE OF INSURANCE <br /> lnsurana� THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY- <br /> 1I0 Ernie Inc.Pt - Erie,PA 16530 CERTIFICATE HOLDER COPY <br /> DATE ISSUED <br /> NAME AND NUMBER OF AGENCY 02/01/2016 <br /> "THE HARPER AGENCY Jill 156 <br /> 1037 S MAIN S7 NAME AND ADDRESS OF CERTIFICATE HOLDER <br /> BURLINGTON , NC 27215-5756 336-227-4271 <br /> NAME AND ADDRESS OF NAMED INSURED <br /> ORANGE COUNTY SOCIAL SERVICES <br /> NICE & GREEN FLOORING 113 MAYO ST <br /> SOLUTIONS LLC HILLSBOROUGH NC, 27278- <br /> 1 183 UNIVERSITY DR 0105-113 <br /> BURLINGTON NC 27215-8303 <br /> This Is to certify that policies,as Indicated by Policy Number below,are in force for the Named Insured at the time that the certificate Is Wing Issued. <br /> 0000 <br /> GENERAL LIABILITY Q390750764 0310712016 013f017/201'I7 tAcHOCCURRENCE $ 100"1" <br /> COM M EPIC IAL GENERAL UABI UTY <br /> OCCURRENCE FORM FIRE DAMAGE S 000 <br /> G EN'L AGGREGATE LIMIT APPLIES (Aryy one premises) 1000 <br /> 10 o <br /> PER:PROJECT <br /> MED EXP(Any orrie person) $ 5000 <br /> PERSONAL&ADV INJURY 1000000 <br /> GENERAL AGGREGATE S <br /> 2000000 <br /> PRODUCTS-COMPIOP AGG S 2000000 <br /> BODILY INJURY <br /> (EACH PERSON) <br /> BODILY INJURY <br /> EACH ACCIDENT <br /> ( <br /> PROPERTY DAMAGE S <br /> BODILY INJURY AND S <br /> PROPERTY DAMAGE <br /> COMBINED <br /> EACH OCCURRENCE <br /> AGGREGATE <br /> STATUTORY <br /> BODILY ACCIDENT S EACH ACCIDENT <br /> INJURY DISEASE S POLICY LiMiT <br /> EACH EMPLOYEE <br /> DESCRIPTION OF OPERA'nONS/LOCA-nONS/VEHICLES/EXCLUSIONS ADDED BY ENOORSEMENTISPECIAL PROVISIONS <br /> CANCELLATION:SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE <br /> DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. <br /> IMPORTANT:It the certificate holder is an I ADDITIONAL INSURED,the poijoyfies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and <br /> conditions of the policy,certain policies may require an endorsement A statement on this certificate does not conter rights to the certificate holder in lieu of such <br /> endorsement(s). -"--6-----------— <br /> THIS CERTIFICATE IS ISSUED FOR INFORMATION PURPOSES ONLY AW ERIE INSURANCE <br /> CONFERS NO RIGHTS ON THE CERTIFICATE HOLDER.IT DOES NOT <br /> AFFIRMATIVELY OR NEGATIVELY LIST,AMEND,EXTEND OR OTHERWISE <br /> ALTER THE TERMS,EXCLUSIONS AND CONDITIONS OF INSURANCE <br /> COVERAGE CONTAINED IN THE POUCYQES)INDICATED ABOVE.THE TERMS SEE REVERSE SIDE <br /> AND CONDITIONS OF THE POLICY(IES)GOVERN THE INSURANCE COVERAGE <br /> AS APPLIED TO ANY GIVEN SITUATION.LIMITS SHOWN MAY HAVE BEEN <br /> REDUCED BY CLAIMS PAID.THIS CERTIFICATE OF INSURANCE DOES NOT <br /> CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZ E—D <br /> REPRESENTATIVE OR PRODUCER AND CERTIFICATE HOLDER. AUTHORIZED <br /> OF-1568 09112 CIF REPRESENTATIVE <br />