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DocuSign Envelope ID:FO3CBAC2-B7E2-4CDB-AFA6-CB52A071BA00 flATEJM!ODFFYYY) -' <br /> AWRD CERTIFICATE OF LIABILITY INSURANCE 1/21/2016 <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 POUCIES <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 e policy,certain policies may r'equ� an endorsement A statement on this cent'este does not confer HOW to the <br /> cora cat holder In lieu of such ender ement(s): <br /> PRODUCER -,._..,._-_..._.... .—,.— .��. �_„_ aE "s U.DA'V'ID ........-�.. o-� .,, .^- ..,...-...-� <br /> BALLARD AGENCY INC I PH•NE (919) 732-2158 919)732-9636 <br /> PO Box 1559 '' enc inc. I„ <br /> _- (FVFoNo <br /> DR ssballard @ballarda• Y com <br /> Hillsborough, NC 27278 Ma,eser¢rel AFFORDING COVERAGE RAMO <br /> INSURER A:GREAT AMERICAN INSURANCE CO <br /> INSURED HISTORIC HILLSBOROUGH COMMISSION INSURER B,: ' <br /> 1 <br /> PO r OX 922'. r I °eSURER.I�- ...� .w..w <br /> 'G3IT�rT.rSaORt•JT�GI� NC 27278 � oR�S DRI'R D 1 ..... ...._ ........._ � <br /> INSURER E: .._..._ . ... .,.._.,. .. ... ... <br /> INSURER F <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS OS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTMTHSTANDING 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 /> erg. �.. • <br /> IILie,' TYPE OF VNSl.URANC:N � r 'rem POU 14'r N4.UMBER m„n�anrl�I�anyY JsMM DowYY LIMITS <br /> w.. ,... � etiu:rl��r EACH OCCURRENCE _..... _... <br /> RREtl"BiC"IF <br /> RFNTED- <br /> CLAIMS-MADE I„.w l OCCUR PREMISES(Ea occurrence) <br /> ' ! MED IELP(Any one person) „ $.. <br /> I PERSONAL A ADV INJURY S <br /> GENIC AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ <br /> POLICY j PRO pi LOC •COMP/OP AGG $ <br /> JECT PRODUCTS <br /> OTHER: <br /> COMBINED SINGLE LJT S AUTrMQB LWLrrY Lt <br /> ALL A BOER)”INJURY(Per person) S <br /> ED SCHEDUCEO EDGILY INJURY(Per accident) yr..... <br /> AUTOS AUTOS <br /> NON-OWNED S <br /> HIRED AUTOS I AUTOS (Par strident) <br /> S . <br /> ' UMBRELLA LIAR OCCUR EACH OCCURRENCE $ <br /> r <br /> EXCESS Li.; CLAUMS-MADE AGGREGATE S <br /> ©ED RETENTIONS Is <br /> SWtIORHLRS I OmMPENSATION CC PTR OTH <br /> LOYERS°L^°5'OW <br /> 1 STATUTE _ . 1 ER <br /> AND ESP : Y,_nrr wrIrnate6LPAmTNEIVEXECtrrofkr. . N <br /> N n 'd. EACHACCUENr _...S <br /> ur c rMLStaE EXCLUDED? <br /> (Wan®uery In MITI E.L DISEASE-EA EMPLOYE S <br /> Ityaa daEaiee under <br /> DESGIRIP 'TIDN Of OPERATIONS below Et DISEASE-POLICY UNIT $ <br /> $1,000,000 OCC WRONGFUL <br /> A DIRECTOR & OFFICERS EPP4917808 1/21/1'•1/21/17ACTS $1,000,000 OCC <br /> LIABILITY EMPLOYMENT PRACTICES <br /> DESCRIPTION OF OPERATIONS r LOCATIONS I VEHICLES (ACORD tog Addili©nal Remarks Schedule,may be attached rf more space is required) <br /> � <br /> CERTIFICATE HOLDER CA NCELLATION <br /> 0', '1 GE CO i^bTY SHOULD ANY OF THE' ABOVE DCSrRIRFO POLICIES BE CANCELLED BEFORE , <br /> "O '18k. TilE 'EAPI TIe�, -1'-FE THEREOF, NOTICE WILL .1E •SLIVERED IN <br /> BOX. <br /> ACCORDANCE WITH THE POLICY PI2OVISIOia5. <br /> HILLSBOROUGH, NC 27278 <br /> AITHO"';'ED REPRESENTATIVE <br /> /-,-.'"'' .,‘.'I'', , /.. ,.,,, .... "' <br /> t 19.;-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD25(2014101) The ACORD name and logo are re stored marks of ACORD <br />