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DocuSign Envelope ID:09B4C2F7-7844-4677-A317-23CDB4F22A9A
<br /> LAWRE-1 OP ID: MG
<br /> '4 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD,YYYY)
<br /> 12/20/2016
<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 POLICIES
<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 the policy,certain policies may require an endorsement, A statement on this certificate does not confer rights to the
<br /> certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT
<br /> NAME: Phillip Allen
<br /> Thompson-Allen,Inc. PONe_-3-659 9 217 — AX_ _
<br /> P.O.Box 100 -ntc,No Ext): 3 - - 6
<br /> __LAI,No)_336-599-6932
<br /> Roxboro,NC 27573 E-MAIL
<br /> Marcia D.Green ADDRESS_.
<br /> _ INSURERIS)AFFORDING COVERAGE NAIL#
<br /> INSURER A:Cincinnati Insurance Company 10677
<br /> INSURED Tommy Lawrence Electrical INSURER e:Cincinnati Casualty Company 28666
<br /> •
<br /> P.O,Box 641
<br /> INSURER C
<br /> Roxboro,NC 27573 �__. ___.—___._. t
<br /> INSURER D: I
<br /> INSURER E:
<br /> _INSURER F
<br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br /> INDICATED. NOTWITHSTANDING 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 /> INSR TYPE OF INSURANCE 'ADDLISUBR POLICY EFF ` POLICY EXP I -.
<br /> L7R LINO,WVD 1 POLICY NUMBER (MMIODJYYYY)!(MMIDD/YYYY)j LIMITS
<br /> A X 'COMMERCIAL GENERAL LIABILITY ; EACH OCCURRENCE S 500,000
<br /> , --i �— i ! I Dpi MKGE TO RENTED
<br /> CLAIMS-MADE ,X OCCUR EPP 0096783 08/16/2016 i 08/16/2017 PREMISES(Es occurrence) $__ 100,000
<br /> • MED EXP(Any one person) $ 5,000
<br /> • PERSONAL&ADV INJURY I$ 500,000
<br /> I GENII_AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 1,000,000
<br /> POLICY( I JE i , LOC PRODUCTS•COMP/OP AGG S 1,000,000 II
<br /> •
<br /> OTHER: ,
<br /> i AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT !s
<br /> 1,000,000 I I _Ea accident)—
<br /> A X ANY AUTO EBA 0096783 08/16/2016 08/16/2017 BODILY INJURY(Per person) 15
<br /> ALL OWNED (- SCHEDULED BODILY INJURY(Per accident)1$
<br /> I AUTOS NON-OWNED PROPERTY DAMAGE —f$
<br /> HIRED AUTOS AUTOS I ,_(Per accident) I
<br /> I $
<br /> X I UMBRELLA LIAB i X j OCCUR EACH OCCURRENCE $ 5,000,000
<br /> A E 1 EXCESS LIAB CLAIMS-MADE 1EPP 0096783 08/16/2016 08/16/2017 AGGREGATE $ 5,000,000
<br /> L L-
<br /> I !DED F RETENTIONS _..------ $ --------...._ ,I
<br /> I WORKERS COMPENSATION I I.
<br /> i PER j 0TH-
<br /> AND EMPLOYERS'LIABILITY YIN t STATUTE , ER _
<br /> �"-
<br /> B I ANY PROPRIETOR/PARTNER/EXECUTIVE I I IEWC 0368238.01 01/01/2016 01/01/20181 EL.EACH ACCIDENT $ 100,000
<br /> I OFFICER/MEMBER EXCLUDED? N/A I !------------ I
<br /> (Mandatory In NH) I E.L.DISEASE_EA EMPLOYEE!$ -- _ 100,000
<br /> ,If yes,describe under I ; I
<br /> :DESCRIPTION OF OPERATIONS below
<br /> •
<br /> _ I E.L.DISEASE-POLICY LIMIT I$ 500,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required)
<br /> EMAIL: Itaft @orangecountync,gov
<br /> •
<br /> j
<br /> CERTIFICATE HOLDER _CANCELLATION
<br /> ORANGCG
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Orange County Government ACCORDANCE WITH THE POLICY PROVISIONS,
<br /> Parks and Recreation
<br /> Lori Taft AUTHORIZED REPRESENTATIVE
<br /> 200 South Cameron Street M r��,D, r en`
<br /> Hillsborough, NC 27278 IDol '0, `0.2,
<br /> ©1988-2014 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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