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DocuSign Envelope ID: C4C456FC- 8OC2 -4F13- 9580- 03C59C6C6245 <br />LAWRE•1 OP ID: MG <br />r ATE (MMIAO /YYYY) <br />CERTIFICATE OF LIABILITY INSURANCE TE(MMI DIYY <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(les) 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 <br />Thompson - Allen, Inc, <br />P. 0. Box 100 <br />Roxboro, NC 27573 <br />Marcia D. Green <br />INSURED Tommy Lawrence Electrical <br />Contractor's Inc. <br />P.O. Box 641 <br />Roxboro, NC 27573 <br />cvm wU i <br />NAmIL_Phillip Allen <br />PHONE FAX <br />{gic N_, Ext)336- 599 -2175 T {Alc, No): 336 -589 -6932 <br />EMAIL <br />ADDRESS: <br />INSURER(S) AFFORDING COVERAGE <br />_ NAIC K <br />INSURER A: Cincinnati Insurance Company <br />10677 <br />INSURER B: Cincinnati Casualty Compaaq _,__ <br />— -- _ <br />28665 <br />INSURER C <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />INSURER a: _ <br />_... <br />INSURER E : <br />08/1612017 <br />INSURER F: <br />EACH OCCURRENCE <br />n a nrn l�C DTICif!ATG All IM1ARFr�• 12FVISlnN NIIMRER' <br />YTHIS 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 />— <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />bZ' <br />I D <br />8 <br />�— <br />POLICY NUMBER <br />POLICY EFF <br />MMIDDIYYYY <br />POLICY ExP <br />MMIDDIYYYY <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />EPP 0096783 <br />08/1612017 <br />08/1612018 <br />EACH OCCURRENCE <br />$ 11000,000 <br />DAMA E TO RE T D <br />PREMISES Ea occurrence <br />1 O0 000 <br />$_ , _-_ <br />MED EXP (Any one person) <br />$ 6,000 <br />PERSONAL & ADV INJURY <br />$ 5_00,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />1 F-71 POLICY X_I JECOT IJ LOC <br />— <br />OTHER: <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />PRODUCTS - COMP/OP AGG <br />$ 1,000,000 <br />$ - -- <br />A <br />AUTOMOBILE LIABILITY <br />X ANY AUTO <br />F— ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />NON -OWNED <br />X HIRED AUTOS X AUTOS <br />EBA 0096783 <br />08/16/2017 <br />08/16/2018 <br />COMBINED SINGLE LIMIT <br />_ (Ea accident) <br />S 1,000,000 <br />_ ...__ <br />BODILY INJURY (Per person) <br />$ <br />BODILY INJURY(Par accident) <br />$ <br />PROPERTY DAMAGE <br />Per acclde t <br />-- <br />$ _ <br />._ <br />S <br />A <br />X <br />UMBRELLA LIAR <br />EXCESS LIAR <br />X <br />OCCUR <br />CLAIMS•MADE <br />EPP 0096783 <br />08116/2017 <br />08116/2018 <br />EACH OCCURRENCE <br />S 5,000,000 <br />AGGREGATE <br />$ _ 5,000,000 <br />DEO RETENTIONS <br />$ <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />iANYPROPRIETOR /PARTNER /EXECUTIVE [YIN <br />OFFICER /MEMBER EXCLUDED? i IN <br />(Mandatory In NH) <br />"yes, desc under <br />DESCRIPTION ribe OF OPERATIONS below <br />NIA <br />EWC0368238 -02 <br />01/01/2018 <br />01101/2019 <br />X STATUTE FOR H <br />E.L. EACH ACCIDENT <br />_ __ <br />S 100,000 <br />E.L, DISEASE • EA EMPLOYEE <br />S 100,000 <br />E.L DISEASE - POLICY LIMIT <br />$ 500,000 <br />DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Romarks Schedule, may be attached If more spaoo Is roquired) <br />EMAIL: Itaft @orangecountyne.gov <br />nen r:AAIr:FI I ATInh] <br />ORANGCG <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Orange County Government <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Parks and Recreation <br />Lori Taft <br />200 South Cameron Street <br />Hillsborough, NC 27278 <br />AUTHORIZED REPRESENTATIVE <br />t \ D Green <br />�j /L�il- --�• —_ <br />V1 VOO-LV 14 /itVMW %,umrVRFiI iVIV. nli riginu rGServvu. <br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD <br />