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DocuSign Envelope ID:FO3CBAC2-B7E2-4CDB-AFA6-CB52A071BA00 DATE ttgtfAitfOrrirq
<br /> ACGREI CERTIFICATE OF LIABILITY INSURANCE 1/21/2016
<br /> 6.------ .
<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 /> 1 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 pollty(les)must be endors .. If SUBROGATION IS WAIVED,subject to
<br /> the tell ,Li;and coadttions of the looney,certain poltclee may require an endorsement A statement on this certificate does not confer rights to the
<br /> contineafe hofder in We or such endordement(s), !
<br /> . —
<br /> PRODUCER NAME j. DAVID BALLARD ,
<br /> BALLARD AGENCY INC PHQ'NIE (919)732-2158
<br /> ' NC NO919)732-9636
<br /> PO Box 1559
<br /> 0055ba11ard@ba11ardagencyinq,.com
<br /> coin
<br /> Hillsborough, NC 27278 INA URER(a) AFFORDING COVERAGE HAMS
<br /> INSURER A:GREAT AMERICAN INSURANCE CO
<br /> INSURED HISTORIC HILLSBOROUGH COMMISSION INSURERS:GREAT AMERICAN INSURANCE CO I
<br /> PO BOX 922 jNsuREIR c 1
<br /> ILLS °ROUGH, "I 'C 27278 oNsuFtER,0
<br /> INSURER E
<br /> INSURER F
<br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br /> 1 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LMISTED BELOW HAVE BNEYENCOISNSUEDCTTOONTHOETNINESRURDOEDCutrENETD ABOVREEFSOPRECTTHETOPOLICICYHPTEHRIISOD
<br /> ICNEDNIrICADTE, NOTreTHESITSASNUDEIDNG6NANY RYEIF.i,IEUNIRTEAMINE TTNETEINRSUORNCCOENADFITIF, BY
<br /> 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, .. , _,....., .
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<br /> TvPr, oF IINSURANCE POLACY NUMBER , ttattfT1'.,P , ! 4i.D .fr,rYY. Lwrrs
<br /> _ .. _{
<br /> COMMERCRAI. OENERAL 6.11LIWO,,mr EACH OCCURRENCE $ 1,,0002_000 1
<br /> X}1 , TAMAGETOTEEfT TlEtr--
<br /> CLA1MS-MADE L dui OCCUR I I 1 PROM $ Ea occurrence , $ 100,000'
<br /> ! , , !
<br /> 12/11/15 '12/11/16 MED EXP(Ahy one person) , s 5,000
<br /> - PAC4816275 1
<br /> Al 1 1PERSONAL&ADV INJURY ' 5 1,000,000
<br /> 1 1
<br /> GEN1 AGGREGATE LIMIT APPLIES PER, GENERAL AGGREGATE !,$ 3,000„000
<br /> X POLICY n 78,--. D Loc
<br /> I
<br /> OTHER:
<br /> ! !
<br /> !
<br /> ! ,
<br /> 1,
<br /> PRODUCTS'COMP/OP AGGIs 3,000,000 Ti
<br /> $
<br /> .....
<br /> AuTOMOSILE LLABUTY , 11E_Lt"PARTIL '
<br /> ANYALIE0
<br /> ALL OWNED ---- SCHEDULED ' :'I
<br /> ,
<br /> '
<br /> , BODa`E nailitrer(Por parson) $
<br /> BODILY INJURY(Per acciderd)I $ '
<br /> AUTOS , AUTOS WN
<br /> NON-OED , $
<br /> HIRED AUTOS AUTOS 1 1 (Per acciden1)
<br /> ,
<br /> ! , S
<br /> X UMBRELLA um l OCCUR umB4816276 '
<br /> EACH OCCURRENCE $ 1 i 000,000
<br /> g EXCESS LIAO ! CLAIMS-MADE I AGGREGATE $ 1 000 000 I
<br /> ' DED I RETE,NTION$10 000
<br /> 12/11/15 12/11/16
<br /> s
<br /> 1,
<br /> ,
<br /> 'WORKERS COMPENSATON 1 IIIII S1'1'AIWIT1 11111 '1E,,11""1
<br /> AND EM,-1„,0YERS'LVdtlLTY
<br /> WY PROPAJETOFWAPIXEORAFXECLPT WE r—1 I E L.EACH ACC*E.NIT $
<br /> OFFICER/MEMBER EXCLUDED? 14 i A
<br /> 1
<br /> QMAndalory la NH) El DISEASE-EA EMPLOYE $
<br /> IEjn5dRIPTIONVI'l!PERATIONS !,:low ,
<br /> I I !
<br /> E.L.DISEASE-POLICY LIMIT!S
<br /> , r ,
<br /> 1 , ,
<br /> , , !
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<br /> , ! '
<br /> 11DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES (ACORD 101 Add/Vona!Remarks Schedule,may be attachoddrnore apace Is required)
<br /> ,
<br /> ,
<br /> CERTIFICATE HOLDER . , CANCELLATION . .
<br /> GE C01111':T'i' SHOULD ANY OF l'HIIII ABOVE DESCRIBED POLICIES (9 CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF NOTICE WU BE DELIVERED IN
<br /> PO %OX 8181 ACCORDANCE WITH WE POLICY PROVISIONS, I
<br /> HILLSBOROUGH, NC 27278
<br /> AUTHORIZED REPRESENTATIVE
<br /> , /
<br /> ■ 041988-2014 ACORD CORPORATION, All' !1.hts reserved,
<br /> ACORD 25(2014/01) The ACORD name and logo are r glstered marks of ACORD
<br />
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