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DocuSign Envelope ID:A034BEFC-1769-4A2A-B443-DC7C17813746 <br /> CERTIFICATE HOLDER'S COPY <br /> °° Erie CERTIFICATE OF INSURANCE DATE ISSUED VMM/D„ Y"'' <br /> Insurance® —THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY— 04/05/17 <br /> Home Office • 100 Erie Insurance Place • Erie,Pennsylvania 16530 • 814,870,2000 <br /> Toll free 1.800.458.0811 • Fax 814 870.3126 • www erieinsurance.com <br /> NAME AND ADDRESS OF AGENCY AGENT'S NO. 8°' ._.. 0 V'1IY1 .,4fl 4Y <br /> Thaggard Insurance Services, Inc. o ti -ERI .I KY .C�UA COMPANY <br /> Co„E f IE I�(SURAN E EXCHANGE (slot Applicable\ <br /> 2014 S. Miami Blvd. tree Indemnity co,l Attorney-In-Fact\\\ in NY <br /> Durham, NC 27703 .1 S A` -COMP" 8F NE ;:.YORK. .. <br /> o; <br /> It i h ' .14h 1 EJN"+L <br /> This certificate is issued for information purposes only and confers <br /> NAME AND ADDRESS OF NAMED INSURED ry no rights on the certificate holder,It does not affirmatively or <br /> Wilkerson Grading Co negatively amend,extend,or otherwise alter the terms,exclusions <br /> Paul Leroy Wilkerson Jr DBA and conditions of insurance coverage contained in the policy ies <br /> Y indicated below. The terms and conditions of the policy(les) <br /> 4600 Brock Drive govern the insurance coverage as applied to any given <br /> Hurdle Mills, NC 27541 situation. Limits shown may have been reduced by claims <br /> paid..This certificate of insurance does not constitute a contract <br /> between the issuing insurer(s), authorized representative or <br /> p by Policy producer and the certificate holder. <br /> This Is to certify that olloles,as indicated b the Polic Number below,are in force for the Named Insured at the time that the Certificate is being issued <br /> co met PM EN II w i P Y �� N <br /> u ric's e.... TYPE OF INSURANCE POI ICYNITMBER MD & M M1P ... LIMI1 b..... <br /> GENERAL LIABILITY <br /> EIRE E � OCCURRENCE E ��COMMERCIALGENERALLIABILITY Q32-2500511 08/25/16 08/25/17 DAMAGE(AnnyO e) h 1,000,000 <br /> LI CLAIMS MADE ®OCCUR MEDEXP(MyDnePerson) .i$..,_...._... _..5000 <br /> PERSONAL&ADV.INJURY $ 1 000,000. <br /> GENEFTALAGCREGATE $....,.,.,. 2,O00a000. <br /> GMT <br /> I7I POLICY AGGREr J PROJECT. <br /> PLIESPER PRODUCTS-COMP/OP AGO $ _..... 2,000.000. <br /> AUTOMOBILE LIABILIT Y BY INJURY <br /> 1.: "ANY AUTO"(OWNED HILE (EACH PERSONI $ <br /> J OWNED GUYI <br /> I_ J R <br /> J HIRED II APIA.WIDENII....._... $ ...... .... <br /> PROPERTYDAMAGE <br /> 0 NON-OWNED BODILYINJURYAND <br /> PROPERTY DAMAGE <br /> I_I GARAGE COMBINED $ <br /> J_.N EXCESS LIABILITY I EACH OCCURRENCE $ .�... .......... ........... <br /> 00 OCCURRENCE AGGREGATE .. .., <br /> _ $ .... ., <br /> J,__..J RETENTION $ 1 <br /> E WORKERS COMPENSATION & Q92-2500280 08/25/16 08/25/17 1 ACCIDENT 100 <br /> , •, <br /> EMPLOYERS LIABILITY BODILY 100,000 EACH ACCIDENT <br /> INJURY DISEASE $ 500,000 POLICY LIMIT <br /> BY DISEASE $ 100,000 EACH EMPLOYEE <br /> ailOTHER <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 /> 1 AUIII 'iI/EDREPRESF.NTATIVE <br /> Orange County Planning and Inspections Department H <br /> PO Box 8181 Hillsborough, NC 27278 <br /> EIG6230 8/11 <br />