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DocuSign Envelope ID: D9548276-DC92-4758-8CCD-B1 E92BCA79E1 <br /> OP ID: DC <br /> C'C)R° CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD1YYYY) <br /> 06/22116 <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 poticy(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 does not confer rights to the <br /> certificate holder In lieu of such endorsement(s). <br /> PRODUCER 919-828-4354 CONTACT <br /> BRADSHER&BUNN INSURANCE NAME: <br /> AGENCY,INC. 919.828-6182 IA/C Ne,Ext): FAX No): <br /> P O BOX 30247 727 W MORGAN ST EMAIL <br /> RALEIGH,NC 27622 ADDRESS: <br /> WILLIAM BUNN <br /> PRODUCER NATUSTO <br /> CUSTOMER ER ID : <br /> INSURER(S)AFFORDING COVERAGE NAIC 0 <br /> INSURED NATURAL STONE INSTALLATION INSURER A:ERIE INSURANCE COMPANY <br /> ALLEN BROOKS BURLESON DBA INSURER R <br /> 1425 GRECIAN WOODS LN <br /> RALEIGH, NC 27606-2584 INSURERC: <br /> INSURER D: <br /> INSURER E: µ� <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 TYPE OF INSURANCE ADDL.SUGR POLICY EFF POLICY EXP <br /> LTR INSR WVD POLICY NUMBER IMMIDDIYYYYI (MMIDDIYYYYI LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 500,0001 <br /> A X COMMERCIAL GENERAL LIABILITY Q30-0120616 06/01/16 06101/17 DAMAGE TO RENTED 500 000 <br /> PREMISES(Ea occurrence) $ , <br /> CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 5,000 <br /> PERSONAL&AOVINJURY $ 500,000 <br /> GENERAL AGGREGATE S 1,000,000 <br /> GENt AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMPIOP AGO $ 1,000,000 <br /> POLICY j _ LOC S <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> (Ea accident) <br /> ANY AUTO <br /> ' <br /> BODILY INJURY(Per person) <br /> ALL OWNED AUTOS <br /> BODILY INJURY(Per accident) $ <br /> SCHEDULED AUTOS <br /> PROPERTY DAMAGE <br /> HIRED AUTOS (Per accident) <br /> NON-0WNED AUTOS $ <br /> S <br /> UMBRELLA LIAB OCCUR LL EACH OCCURRENCE S <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE S <br /> DEDUCTIBLE $ , <br /> RETENTION S S <br /> WORKERS COMPENSATION WC STATU- 0TH- <br /> AND EMPLOYERS'LIABILITY YIN TORY LIMITS I ER <br /> A ANY PROPRIETOR/PARTNER/EXECUTIVE • Q90-0101139 06/01116 06/01/17 E.L.EACH ACCIDENT S 100,000 <br /> OFFICER1JEMBER EXCLUDED? N/A <br /> (Mandatory In NH) E .DISEASE-EA EMPLOYEE 5 100,000 <br /> If Yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Addillonal Remarks Schedule,If more space Is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> ORAN818 <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 /> haft @orangecounlync.gov ACCORDANCE WITH THE POLICY PROVISIONS. <br /> P.O.Box 8181 <br /> Hillsboro,NC 27278 AUTHORIZED REPRESENTATIVE <br /> WILLIAM BUNN <br /> OO 1988-2009 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD <br />