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DocuSign Envelope ID:C8F16CD1-FF19-486F-8DD6-57316D1FCD54 <br /> nii Erie CERTIFICATE OF INSURANCE DATE ISSUED(MOONY) <br /> insurance° 1/18117 <br /> -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.erieinsurance.com . <br /> NAME AND ADDRESS OF AGENCY GENT'S NO. II i'' p i• G COVERAGE <br /> THE BALLARD AGENCY INC iNC �, ERIE 'TEA_ �1� <br /> 105 W KING ST JJ 1 010 Co LL;111I►a 1 ['1ri:'• .iVICIV T.to'�CCO Agri <br /> HILLSBOROUGH,NC 27278-2543 Co.:E VIE INSU•'1 5'C A Not App cal e <br /> r e Indemnl �y o. 'ttorn; -In-Fact 11t y <br /> �ptad:111 . 104∎Iykilrh,:Zh1 a IZI�rIr,tiAI:T <br /> (919)732-2158 r ei��'T �.i7i1 1 .�111:Tc1∎[141191 1711 <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 /> HILLSBOROUGH ARTS COUNCIL and conditions of insurance coverage contained in the policy(ies) <br /> 102 N.CHURTON ST. Indicated below.The terms and conditions of the policy(ies)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 Insured at the time that the Certificate is being issued. <br /> !! 'qppy 1}ry r)s{ Mile' LIMITS _ <br /> LTR Ins d TYPE OF INSURANCE POLICY NUMBER MI A,Idl`111r ur 1 U:li , ,I)r 11,17 —._ <br /> E ®GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> Q32 1000580 8/10/16 8/10/17 <br /> ®COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any One Fire)$ 1,000,000 <br /> ❑CLAIMS MADE ®OCCUR MED EXP(My One Person) I S 5,000 <br /> 0 I PERSONAL&ADV.INJURY I S 1,000,000 <br /> ❑ GENERAL AGGREGATE Is 2,000,000 <br /> GEN'L AGGREGATE UMIT APPLIES PER,' PRODUCTS-COMP/OPAGG,S 2,000,000 <br /> ❑POLICY ❑PROJECT ❑LOCI I <br /> 0 AUTOMOBILE LIABILITY ' ! BODILY INJURY <br /> ❑"ANY AUTO"'NON OWNIED)' BODILY INJURY I S <br /> ❑OWNED (EACH ACCIDENT) I S <br /> ❑HIRED i PROPERTY DAMAGE I.S <br /> ❑NON-OWNED BODILY INJURY AND <br /> PROPERTY DAMAGE S <br /> ❑GARAGE I I COMBINED ii <br /> Q EXCESS UABIUTY I EACH OCCURRENCE IS <br /> ❑OCCURRENCE AGGREGATE IS <br /> S <br /> ❑RETENTION s IS <br /> i I I <br /> E WORKERS COMPENSATION& I 1/18/17 , 1/18/18 STATUTORY <br /> EMPLOYERS LIABILITY I Q58 1800607 BODILY' ACCIDENT S 500,000 EACH ACCIDENT <br /> INJURY' DISEASE S 500,000 POLICY LIMIT <br /> BY I DISEASE S 500,000 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 /> ORANGE COUNTY AUTHORIZED REPRESENTATIVE <br /> PO BOX 8181 <br /> HILLSBOROUGH,NC 27278 <br /> . --A.)/2...i77---;1-:,4" ,"" <br /> EIG6230 8/11 Page I of 1 <br />