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DocuSign Envelope ID: 28CB79EF -B9B2- 4055 - 9390- 8AF3AAE6894E <br />DocuSign Envelope ID: 2A12972A- 7D21- 4D74- AD4C- A79339548F21 <br />LAWRE -1 OP ICI: MG <br />AG"C7RL7 CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MMIDDIYYYY) <br />12128/2017 <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. It 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 />PRODUOER <br />P. 0. Box 100 en, Inc. <br />P. O. Sox 1 D4 <br />Roxboro, NC 27673 <br />Marcia D. Green <br />cA. roar Phillip Allen <br />PI QII o si 4 336 -599 -2475 �(R1O, Nag 336 - 599.8832 <br />E-MAIL <br />ADM OS: <br />INSURER 8 APPQAOIN+3 COVERAGE <br />NAIL li <br />_ <br />INSURERA- CIn01nnatl Insurance C.om pa n <br />10677 <br />0811612017 <br />_ <br />INSURER _ Tommy Lawrence Electrlcat <br />IN8uRaR9,Clncinn0t1 Casualty Company <br />28665 <br />Contractor's Inc. <br />P.O. Box 641 <br />INSUReRC; <br /># 100,00 <br />MSR EXP An one oon) <br />Roxboro, NC 27573 <br />INSURER 0; <br />PERSONAL a ARV )NMRY <br />$ 600,000 <br />GE N% AGGREGATE LIMIT APPLIES PER: <br />PRO- <br />POLICY I -_ 1 ,IECT <br />OTHER: <br />INSURERS ; <br />$ 2,000,00 <br />INSURBR F t <br />S 4,000,D0 <br />^r,VC'o AP-CC C ERTWIC`.ATE NIIELSF3FR! REVISION NUMBER: <br />v THIS 15 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 />EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY RAVE BEEN REDUCED BY PAID CLAIMS, <br />ILTR <br />TYPE OF INSURANCE <br />ADDL <br />$ <br />POLICY NUMSER <br />P4 I E !< <br />1 MfGR <br />POl� EXP <br />MM1DD YY <br />LIh1178 <br />A <br />X <br />COMMERCIAL eENERAL LIABILITY <br />cLruMS MADE 1K OCCUR <br />EPP 00987$3 <br />0811612017 <br />081181201$ <br />EACH OCCURRENCE <br />3 11000.00 <br />DAMAGE TO E a o ao <br /># 100,00 <br />MSR EXP An one oon) <br />$ Sp <br />PERSONAL a ARV )NMRY <br />$ 600,000 <br />GE N% AGGREGATE LIMIT APPLIES PER: <br />PRO- <br />POLICY I -_ 1 ,IECT <br />OTHER: <br />GENERAL AGGREGATE <br />$ 2,000,00 <br />PROD PROOUC7S- CCMPMPA(30 <br />S 4,000,D0 <br />S <br />A <br />AUTOMOB ILE LEASIL€TY <br />X ANY AUTO <br />ALL OS NED SCHEDULED <br />NON-OWNER <br />X H1RFDAUTOS AUTOS <br />EBA 0096783 <br />08116/2017 <br />0811612018 <br />LE COMeiNEUSINGLE €T <br />Ee alacldtrkl <br />S 4,000,000 <br />BODILY INJURY (Per Parton) <br />i <br />BODILY INJURY (Perwadent) <br />8 <br />PROPER LMMAQP. <br />Po o I: <br />8 <br />s <br />A <br />X <br />UMBRELLA LLAB X <br />EXCESS UAS <br />OCOUR <br />CLAIMS -MADE <br />EPP 0096783 <br />0811612047 <br />0811612048 <br />EACH OCCURRENCE <br />S 6,000,040 <br />AGGREOATE <br />$ 6,000,000 <br />CEO I I RETENTIONS <br />13 <br />WORKERS COMPENSATION <br />ANR EMPLOYERS' LIABILITY <br />ANY PROPRIETORIPARTNEWEXECUTIVE Y' N <br />OPFICERrMEMBER EXCLUDED? � <br />(Ms ndratory InNH) <br />'UI( et d,11 under <br />StRIPTION OF OPERATIONS bet. <br />N ! A <br />EW C 0368238.02 <br />011011201a <br />6110112019 <br />)(. <br />E.L. EACH ACCIDENT <br />z 100,000 <br />E. L, DISEASE EA EMPLOYEE <br />i 100,e00 <br />E.L. DISEASE * POLICY LIMIT <br />! 5t}O,U00 <br />DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORG tot, Additnol Rarrtttrks Sobadule, may ho 040'hod If Moro tpt ®o Is roqulrad) <br />EMAIL: Itaft@orangecountyne.gov <br />l MM IUIIIA'ru Lint tir.* CANCELLATION <br />ORANGCG <br />SHOULD ANY OF THE A13OVE DESCRIBER 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 />AUTNOR€t @D REPRESENTATIVE <br />200 South Cameron Street <br />Hillsborough, NC 27278 <br />Is D G @ n r <br />@ 1988.2014 ACORD CORPORATION. All rights reserved. <br />ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD <br />