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DocuSign Envelope ID:51F879E8-7702-4D23-B2F8-FA67BE720A84 <br /> i, Erie CERTIFICATE OF INSURANCE DATEISSUED(MM/DD/YY) <br /> I nsuranc 06/16/2017 <br /> -'THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY— <br /> Home Office • 100 E he Insurance Place • Erie,Pennsylvania 16530 • 814 870,2000 <br /> To9I free 1.800.458.0811 • Fax 814.870.3126 • www ene(nsurance.com o�p E p,� <br /> NAME AND ADDRESS OF AGENCY CENTRAL CAROLINA INSURANCE INC AGENT'S NO. Co.: C ERIE INSURANCE COMPANY G COVERAGE <br /> 2855 S CHURCH ST STE C JJ 1490 Co.: D ERIE INSURANCE PROPERTY&CASUALTY COMPANY <br /> BURLINGTON,NC 27215-5300 Co.: E ERIE INSURANCE EXCHANGE (Not Applicable\ <br /> Erie Indemnity Co.,Attorney-in-Fact , in NY 1 <br /> Co.: F ERIE INSURANCE COMPANY OF NEW YORK <br /> (336)524-0209 , 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 /> Palmer Consulting Group LLC and conditions of insurance coverage contained in the policy(ies) <br /> 3673 Alamance Rd indicated below.The terms and conditions of the policy(ies)govern <br /> the insurance coverage as applied to any given situation.Limits <br /> Burlington,NC 27215 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 Insured at the time that the Certificate is being issued. <br /> CO LTR ns ' TYPE OF INSURANCE POLICY NUMBER RTE lMM%DD/y DAITEDD/yY)N LIMITS <br /> E ® GENERAL IJABILITY Q32 2500735 8/25/16 8/25/17 EACH OCCURRENCE $ 1,000,000 <br /> XI COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any One Fire) $ 1,000,000 <br /> I I CLAIMS MADE [X] OCCUR MED EXP Any One Person) $ 5,000 <br /> I I PERSONAL&ADV.INJURY $ 1,000,000 <br /> I I GENERAL AGGREGATE $ 2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG$ 2,000,000 <br /> I XI POLICY I I PROJECT I I LOC <br /> E AUTOMOBILE LIABILITY BODILY INJURY <br /> I I "ANY AUTO"(ON ODWINIEE), Q04 0132630 4/1/17 4/1/18 (EACH PERSON) $ <br /> X OWNED BODILY INJURY <br /> (EACH ACCIDENT) $ <br /> I I HIRED PROPERTY DAMAGE $ <br /> I I NON-OWNED BODILY INJURY AND <br /> PROPERTY DAMAGE 1,000,000 <br /> I I GARAGE COMBINED <br /> EXCESS LIABILITY Q32 2570222 8/25/16 8/25/17 EACH OCCURRENCE $ <br /> I XI OCCURRENCE AGGREGATE $ 2,000,000 <br /> I I RETENTION $ $ <br /> E WORKERS COMPENSATION& STATUTORY <br /> EMPLOYERS LIABILITY Q86 1100729 2/11/17 2/11/18 ACCIDENT $ 1,000,000 EACH ACCIDENT <br /> BODILY <br /> INJURY DISEASE $ 1,000,000 POLICY LIMIT <br /> BY DISEASE $ 1,000,000 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 /> AUTHORIZED REPRESENTATIVE <br /> Orange County Planning and Inspections Department #0116- �, <br /> 131 W.Margaret Lane(P.O.Box 8181) �'v <br /> Hillsborough,NC 27278 <br /> EIG6230 8/11 <br /> Page 1 of 2 <br />