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DocuSign Envelope ID: 2A12972A- 7D21- 4D74- AD4C- A79339548F21
<br />LAWRE -1 OP 1D: MG
<br />CERTIFICATE OF LIABILITY INSURANCE DA12r2TE(MM t�rxol/2011 YY,
<br />7
<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($), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(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 />CONTACT
<br />PRODUCER
<br />NAME: Phillip A11E:n T
<br />Thompson - Allen, Inc, PHONE x$$ -699- 2'1"75 f
<br />P. 0. Box 100 (AIC. No, Exti3 . prc, Not: 336- 599 -6932
<br />Roxboro, NC 27673 ADDRESS_ -
<br />Marcia D, Green
<br />NRIC R
<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 AUTHORIZEOREPRESENTATIVE
<br />200 South Cameron Street M D Gre n r
<br />Hillsborough, NC 27278
<br />@ 1988.2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 26 (2414101) The ACORD name and logo are registered marks of ACORD
<br />INSURER {S) AFFORDIN{3 COVERAGE
<br />_,
<br />INSURERA:Cincinnatl. Insurance Company
<br />-
<br />10677
<br />--..... r..._-- ........_..— ........,.._ ..
<br />INSURED Tommy Lawrence EieGtrical
<br />INSURER B: Cincinnati Casualty Company
<br />28665
<br />Contractor's Inc.
<br />INSURER 0:
<br />P.O. Box 641
<br />Roxboro, NC 27573
<br />INSURER 0:
<br />INSURER E ;
<br />INSURER P
<br />COVERAGES CERTIFICATE NUMBER:
<br />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
<br />PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION
<br />OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED
<br />BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL
<br />THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE
<br />BEEN REDUCED BY PAID CLAIMS.
<br />S
<br />IN R TYPE OF INSURANCE J p POLICY NUMBER
<br />OLICY EFF POLICY EXP
<br />MMfDPNYYY MM ODNYYY _ _ _ LIMITS
<br />A X COMMERCIALGENERALLIA13ILITY
<br />EACH OCCURRENCE $
<br />1,000,000
<br />--.... CLAIMS -MADE rol OCCUR EPP 0096783
<br />0$11612017 0811812018 pAMAGE TO RENTED
<br />Ea ac urrewCe. $
<br />100,400
<br />ME EXP (Any one person) S
<br />5,000
<br />PERSONAL $ ADV INJURY S
<br />800,080
<br />GEN'L AGGREGATE LIMIT APPLIES PER.
<br />GENERAL AGGREGATE $
<br />2,000,000
<br />POLICY "- JECOT LDC
<br />PRODUCTS - COMPfOPAGG S
<br />1,0D4,440
<br />I ! i
<br />OTHER:
<br />LIMIT S
<br />�a�d
<br />'1,000,00{1
<br />AUTOMOBILE LIABILITY
<br />rtiS1NGLE
<br />A X EBA 0096783
<br />08116/2017 081161201$ BODILY VNJURY (Par Person) s
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />BODILY INJURY (Paraccidenl) 9
<br />AUTOS NON-OWNED
<br />X
<br />PROPERTY DAMAGE 5
<br />IPeraccldetltl
<br />-- -
<br />HIRED AUTOS AUTOS
<br />5
<br />X UMBRELLA LIAR X OCCUR
<br />EACH OCCURRENCE S
<br />6,000,000
<br />A EXCESS LIAS CLAIMS -FADE EPP 0096783
<br />09116/2017 0811$12018 AGGREGATE $
<br />5,000,400
<br />t DED RETENTIONS
<br />3
<br />X $7qT
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />B ANY PROPRIETORJPARTNERIEXECUTIVE YIN EWC036823B ^02
<br />E _ ER
<br />01101/2418 011'0'112'0'15 E.L. EACH ACCIDENT � $
<br />_
<br />140,440
<br />orFIC£RWRABER EXCLUDED? N f A
<br />E.L. gISEASE • EA EMPLOYEE 5
<br />140,044
<br />jMandatory In NHj
<br />If es,desctlbenndef
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT $
<br />604,000
<br />DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101, AddRienal Remarka Schedule, may fie attached If more $P00 Is requlred}
<br />EMAIL.: Itaft @orangecountyne.gov
<br />CERTIFICATE HOLDER
<br />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 AUTHORIZEOREPRESENTATIVE
<br />200 South Cameron Street M D Gre n r
<br />Hillsborough, NC 27278
<br />@ 1988.2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 26 (2414101) The ACORD name and logo are registered marks of ACORD
<br />
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