Orange County NC Website
Browse       Search
DocuSi n Envelope ID:80528E57-64B2-4BCE-A558-776533408604 <br /> F� Erie CERTIFICATE OF INSURANCE DATE ISSUED(MM/DD/>'1') <br /> Insurance® -THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY— 7/12/17 <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 THE BALLARD AGENCY AGENT'S NO. INSUhA I GU RUG COVERAGF <br /> JJ1010 _Co.:C ERIE INSUh I\Gt GU f'A Y <br /> 105 W KING ST Co.:D ERIE INSURANCE PROPERTY_&CA SUALTY COM AN <br /> HILLSBOROUGH,NC 27278-2543 Co.:E ERIE INSURANCE EXCHANGE, Not App'cal le <br /> Erie Indemnity Co.,Attorney-In-Fact k inNY__ <br /> Co.:F ERIE INSURANCE COMPANY OF NEW YORK <br /> (919)732 2158 Co.:G FLAGSHIP CITY INSURANCE COMPANY <br /> This certificate is issued for information purposes only and conf'•rs <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 /> HISTORIC HILLSBOROUGH and conditions of insurance coverage contained in the policy(ies) <br /> COMMISSION indicated below.The terms and conditions of the policy(ies)govern <br /> the insurance coverage as applied to any given situation.Li its <br /> PO BOX 922 shown may have been reduced by claims paid.This certificate",of <br /> insurance does not constitute a contract between the issu ng <br /> HILLSBOROUGH,NC 27278 insurer(s), authorized representative or producer and he <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 /> 1 [(��11 ��11►1 �1 tq�y ` <br /> TR nsad TYPE OF INSURANCE ;,POLICY NUMBER r,h,'Nei 14 �I N ,'i f iii LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ <br /> COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any One Fire) $ <br /> ❑ CLAIMS MADE ❑ OCCUR MED EXP(Any One Person) $ <br /> ❑ PERSONAL&ADV.INJURY $ <br /> ❑ GENERAL AGGREGATE $ <br /> GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG$ <br /> ❑POUCY I I PROJECT ❑LOC <br /> I AUTOMOBILE LIABILITY BODILY INJURY <br /> ❑ "ANY AUTO"(ON ODI,H D), (EACH PERSON) $ <br /> 11 OWNED BODILY INJURY <br /> (EACH ACCIDENT) $ <br /> ❑ HIRED PROPERTY DAMAGE $ <br /> I I NON-OWNED BODILY INJURY AND <br /> PROPERTY DAMAGE <br /> El GARAGE COMBINED $ <br /> I 1 EXCESS LIABILITY EACH OCCURRENCE $ <br /> ❑ OCCURRENCE AGGREGATE $ <br /> ❑ RETENTION $ $ <br /> E WORKERS COMPENSATION& STATUTORY <br /> EMPLOYERS LIABILITY Q86 0600392 2/6/17 2/6/18 ACCIDENT $ 500,000 EACH ACCIDENT <br /> BODILY <br /> INJURY DISEASE $ 500,000 POLICY LIMIT <br /> BY DISEASE $ 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 /> 601,0/.1v41 <br /> EIG6230 8/11 Pane 1 of 1 <br />