|
DocuSign Envelope ID:9507D755-14CD-4FOC-A7AF-0B572F4D3DB8
<br /> 1
<br /> Erie
<br /> 111 e CERTIFICATE OF INSURANCE DATE ISSUED(MMI/DD/YY)
<br /> 8/28/17
<br /> Z4.44"444. 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 0811 • Fax 814 870 3126 • WWw enensurance corn
<br /> NAME AND ADDRESS OF AGENCY 13AREF(/(1T INSURANCE GROUP INC AGENTS NO. _ •■A 4,,,,i,i I I ,:, 11:I 1 0
<br /> Co.:E—ER 1 11,1 0.41v
<br /> 2014 S MAIN ST sTE 606 JJ3437 Co.; ERIE IN RAN E PROPERTY&CASUA TY COMPANY
<br /> Co,:E ERIE INSURANCE EXCTANGE Not Applicable\
<br /> WAKE EoRt,;sT,N(' 27587-4339 Erie Indemnity Co.,Atorney-in-Fact k n NY
<br /> 82:::FG atigTifftiWXAFE(.86.4PA:11(DRK
<br /> (919)217-5870 This certificate is issued for information purposes only and confers
<br /> VAIVEAiiifiAlifillEtS-lif NAMED INSURED no rights on the certificate holder. It does not affirmatively or
<br /> negatively amend,extend,or otherwise alter the terms,exclusions
<br /> UPS MOBILE SOLUTIONS INC and conditions of insurance coverage contained in the policy(ies)
<br /> indicated below.The terms and conditions of the polleylies)govern
<br /> 92()PAVERSTONE 1)R STE F2 the insurance coverage as applied to any given situation.Limits
<br /> RALEIGH, NC 27615-4723 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 /> 5 fAndel TYPE OF INSURANCE POLICY NUMBER .1 REAF/EEN% PRE ; 1. it LIMITS
<br /> ,,...., , . , , ., _ _ _,....,__ ., ___ ___ _
<br /> E fl utNERAL LIABILITY
<br /> Q97 0073701 9/4/I 7 9/4/18 ,EACH OCCURRENCE $ 12,900,000
<br /> FX.1 COMMERCIAL GENERAL LIABILITY FIRE DAMAGEAM One Firs ', 1,000,000
<br /> El CLAIMS MADE [xi OCCUR MED EXPIRDINPqrsoiB $ 5,000
<br /> ,
<br /> Li PERSONAL&ADM INJURY $ 1,000,p00
<br /> GENERALAGGREGATE $ 2,000,(100
<br /> GEN't AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG$ 2,000,000
<br /> [X1 POLICY 1. .1 PROJECT C1 LOC
<br /> . ,.
<br /> E FA AUTOMOBILE LIABILITY 4 2 BODILY INJURY
<br /> tg -ANY AUTO"(OWNED HIRED, Q09 0430543 9/4/17 9/4/....., pa001$04 $
<br /> BODILY INJURY „,
<br /> FS] OWNED (EACH mow ..4.
<br /> LX HIRED PROPERTY DAMAGE $
<br /> Egi NON-OWNED BODILY INJURY AND
<br /> PROPERTY DAMAGE t 1 000 000
<br /> Cl GARAGE COMBINED ‘P ' '
<br /> E El EXCESS LIABILITY E,AGILOMRRENCE $ 1,000,000
<br /> Q33 0470171 9/4/17 9/4/18 ---
<br /> [S] OCCURRENCE MGREGATE _,.. $ 1,000,000
<br /> $
<br /> Lill RETENTION $
<br /> 9/4/18 BODILY
<br /> E WORKERS COMPENSATION&
<br /> EMPLOYERS LIABILITY Q93 0400496 9/4/17 ACCIDENT $ 1,000,000 EACH ACCIDENT"
<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 /> , .
<br /> NAME AND ADDRESS OF CERTIFICATE HOLDER
<br /> ORANGE COUNTY AUTHORIZED RicRERE TAME
<br /> PO BOX 8181
<br /> IIILLSBOROTJG11, NC 27278
<br /> EIG6230 8/11 . —
<br /> Page 1 of 1
<br />
|