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DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C <br />Page 1 of 1 <br />Erie CERTIFICATE <br />OOIYY) <br />OF INSURANCE DATE ISSUED(MMI ) <br />1119/ 18 <br />/ � lnsurana:^ —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 81070.3126 • www.erieinsurance.com <br />NAME AND ADDRESS OF AGENCY THE BALLARD AGENCY <br />AGENT'S N0. <br />GE <br />105 W KING ST <br />� i,l 1010 <br />• v - _ <br />moo.. d _E8tORS JRANNGETROOMURTY_ &CAS. Ty <br />HILLSBOROUGH, NC 27278 -2543 <br />Co.: E ERIE INSURANCE EXCHANGE• of App ica e <br />Ene Indemnity- Ca�Attorney in Fact I N <br />RIE INSURANC 0— PANY -OF N <br />Ma <br />(919 )732 -2158 <br />This certificate is issued for information purposes only and confers <br />no rights on the certificate holder, It does not affirmatively or <br />NAME AND ADDRESS OF NAMED INSURED <br />negatively amend, extend, or otherwise alter the terms, exclusions <br />Historical Foundation of <br />and conditions of insurance coverage contained in the poiicy(ies) <br />indicated below. The terms and conditions of the poHcy(ies) govern <br />Hillsborough &Oran e Co Inc <br />the insurance coverage as applied to any given situation. Limits <br />201 N Churton St <br />shown may have been reduced by claims paid. This certificate of <br />insurance does not constitute a contract between the issuing <br />Hillsborough, NC 27278 <br />insurer(s), authorized representative or producer and the <br />certificate holder. <br />This Is to certify that policies, as Indicated btjqePolic Number below, are in force for Named Insured at the time that the Certificate is being Issued. <br />EthTTeI <br />d i q <br />POLICY NUMBERiMQ1Y. <br />ATEylAthht� LIMITS <br />TYPE QF INSURANCE <br />E GENERAL LIABILITY Q44 2250193 8122117 <br />8122118 EACH OCCURRENCE 1 000,000 <br />® COMMERCIAL GENERAL LIABILITY <br />FIRE DAMAGE Any One Fire ) $ 1.000,000 <br />❑ CLAIMS MADE ❑ OCCUR <br />MED EXP (Any One Person , 5,000 <br />❑ <br />PERSONAL & ADV. INJURY S 1.000.000 <br />❑ <br />GENERAL AGGREGATE 2,000,000 <br />GENT AGGREGATE LIMIT APPLIESPER <br />PRODUCTS- COMPIOPAGG 5 2.000,000 <br />POLICY ❑ PROJECT ❑ LOC <br />❑ AUTOMOBILE LIABILITY <br />BODILY INJURY <br />EACH PERSON) S <br />❑ "ANYAUTO" (OWNED 1 HIRE " <br />❑ OWNED <br />ACHLACCIDENT $ <br />❑ HIRED <br />PROPERTY DAMAGE S <br />❑ NON -OWNED <br />BODILY INJURY AND <br />PROPERTY DAMAGE <br />❑ GARAGE <br />COMBINED $ <br />�] EXCESS LIABILITY <br />EACH OCCURRENCE S <br />❑ OCCURRENCE <br />AGGREGATE S <br />I <br />�S <br />❑ RETENTION S <br />S <br />L WORKERS COMPENSATION & Q92 2200217 5%2'2 17 <br />SMUTORY <br />N!21 i 1 ACCIDENT S 300.000 EACH ACCIDENT <br />EMPLOYERS LIABILITY <br />BODILY <br />INJURY, DISEASE S 500.000 POLICY LIMIT <br />I <br />BY DISEASE S 500.000 EACH EMPLOYEE <br />OTHER <br />DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES /EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL 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(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the <br />terms and conditions of the policy, Certain policies may <br />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 />� <br />ESENTATIVE <br />Orange County <br />AUTHORIZEOREP <br />P O Box 8181 <br />Hillsborough, NC 27278 <br />Page 1 of 1 <br />