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DocuSign Envelope ID:00CA9FB4-CE9C-491 B-B714-F1 B722606E01 <br /> Erie CERTIFICATE OF INSURANCE DATEISSUED(MM/DD/YY) <br /> 1/31/17 <br /> Insurance® -THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY— <br /> Home Office • 100 Erie Insurance Place • Erie,Pennsylvania 16530 • 814.870.2000 <br /> Toll free 1.800.458.0511 • Fax 814 870 3126 • www,erieinsurance.com C�Mp�Ny(ES q�Fp p�N <br /> NAME AND ADDRESS OF AGENCY THE BALLARD AGENCY INC AGENT'S NO. • ERIE fNSURANCE COMP�NY G COVERAGE <br /> 105 W KING ST JJ1010 , DPgllIMAEI;,;X;O];Zq;11E3 �TLL�L 1M'ANY <br /> HILLSBOROUGH,NC 27278-2543 Co.:E ErRIEl demist VCCoE Attorney-in-Fact N of Applicable in <br /> Co.:F ERIE INSURANCE COMPANY OF NEW YORK <br /> 919 732-2158 Co.:G FLAGSHIP CITY INSURANCE COMPANY <br /> This certificate is issued for information purposes only and confers <br /> NAME AND ADDRESS OF NAMED INSURED no rights on the certificate holder.It does not affirmatively or <br /> negatively amend,extend,or otherwise alter the terms,exclusions <br /> FRANCISCO PLAZA and conditions of insurance coverage contained in the policy(ies) <br /> 806 SPRING STREET indicated below.The terms and conditions of the policy(i es)govern <br /> the insurance coverage as applied to any given situation.Limits <br /> HILLSBOROUGH,NC 27278 shown may have been reduced by claims paid.This certificate of <br /> insurance does not constitute a contract between the issuing <br /> insurer(s), authorized representative or producer and the <br /> certificate holder. <br /> This is to certify that policies,as indicated by the Policy Number below,are in force for the Named l Insured at the time that the Certificate is being issued. <br /> CO ns d TYPE'OF INSURANCE POLICY NUMBER T1TF1IdMFf3 PISA7Y(A�1�/11I1N ' LIMITS <br /> E ®GENERAL LIABILITY C)25 3021227 1/30/17 1/30/18 EACH OCCURRENCE $ 1,000,000 <br /> © COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any One Fire) $ 1,000,000 <br /> ❑CLAIMS MADE © OCCUR MED EXP(Any One Person) $ 5,000 <br /> ❑ <br /> PERSONAL&ADV.INJURY'$ 1,000,000 <br /> ❑ GENERALAGGREGATE $ 2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG$ 2,000,000 <br /> ©POLICY ❑PROJECT ❑LOC <br /> ❑ AUTOMOBILE LIABILITY BODILY INJURY <br /> ❑ <br /> ANY AUTO"(NON OWNED), (EACH',PERSON) $ <br /> ❑ OWNED BODILY INJURY <br /> (EACH ACCIDENT) $ <br /> ❑HIRED PROPERTY DAMAGE $ <br /> ❑ NON-OWNED BODILY INJURY AND <br /> PROPERTY DAMAGE' <br /> ❑ GARAGE COMBINED $ <br /> ❑EXCESS LIABILITY EACH OCCURRENCE $ <br /> ❑ OCCURRENCE AGGREGATE $ <br /> ❑ RETENTION $ $ <br /> WORKERS COMPENSATION& STATUTORY <br /> EMPLOYERS LIABILITY BODILY ACCIDENT $ EACH ACCIDENT <br /> INJURY DISEASE $ POLICY LIMIT <br /> BY DISEASE $ EACH EMPLOYEE <br /> OTHER <br /> DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br /> CANCELLATION: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIV- <br /> ERED IN ACCORDANCE WITH THE POLICY PROVISIONS. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the <br /> terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer <br /> rights to the certificate holder in lieu of such endorsement(s). <br /> NAME AND ADDRESS OF CERTIFICATE HOLDER <br /> ORANGE COUNTY AUTHORIZED REPRESENTATIVE <br /> PO BOX 8181 <br /> HILLSBOROUGH,NC 27278 <br /> EIG6230 8/11 <br /> Page 1 of 1 <br />