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DocuSign Envelope ID:95724FC4-3213-43D4-8D2C-2A793885F3F8
<br /> f—Wll OR ID:CR
<br /> 14C-C3R"` CERTIFICATE OF LIABILITY INSURANCE DA 0411 8/2 01 8
<br /> �� 041 sl201 s
<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(ies)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 endorsements).
<br /> PRODUCER CONTACT
<br /> High&Rublsh insurance Agency PHHONN Jeffre A.Rubish FAX
<br /> P.O.Box 3040 1AIC,No,E*I=919-913-1144 AIC,No#:919-913-1155
<br /> 6015 Farrington Rd.Ste 101 E-M1AIL
<br /> Chapel Hill,NC 27517 ADDREss.Jeff @highandrubish,eom
<br /> Jeffrey A.Rubish CUSTOMER le u:Sf'ARRA
<br /> INSURER(S)AFFORDING COVERAGE _ NAIC N
<br /> INSURED Sparrow&Sans,Inc. INSURER A:Erie Insurance Exchange 26271
<br /> 305 Weaver St. INSURER B:Erie Insurance Company 26263
<br /> Carrboro,NC 27510
<br /> INSURER C:
<br /> INSURER D:
<br /> INSURER E:
<br /> !.SURER F:
<br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN 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 /> ILTR TYPE OF INSURANCE DD -�R POLICY NUMBER. MMIDDfy y POLICY
<br /> MA]OIYYYPY --- LIMITS
<br /> GENERAL LIABILITY EACH OCCURRENCE S 1,000,00
<br /> DAMAGE A COMMERCAL GENERAL LIABILITY PREMISES Ea ocwnence $ 1,000,00
<br /> _
<br /> CLAIMS-MADE FX-1 OCCUR MED EXP(Any one person)I $ --- 5,00
<br /> Q370162886 01/01/2018 01101/2019 PERSONAL&ADV INJURY $ 1,000,00
<br /> GENERALAGGREGATE 5... - - 2,000,00
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,00
<br /> POLICY X PRO- LOC S
<br /> AUTOMOBILE LIABILITY COMBINED
<br /> ilJANGLELIMIT S 1,000,00
<br /> A X ANY AUTO Q0101444$7 a11a1rz01$ 0110112019 BODILY INJURY(Per person) S
<br /> ALL.OiMJED AUTOS - "-
<br /> BODILY INJURY(Per acddent) S
<br /> SCHEDULEDAUTOS PROPERTY DAMAGE
<br /> X HIRED AUTOS (PER ACCIDENT)
<br /> X NOWOWNED AUTOS S
<br /> S
<br /> UMBRELLA LIAR X OCCUR EACH OCCURRENCE__ S_ 5,000,00
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE S
<br /> A Q250171220 01/01/2017 0110112019 --
<br /> DEDUCTIBLE _ _ $
<br /> X RETENTION $ 10000. $
<br /> WORKERS COMPENSATION X NG ITORYtIMIT T iFR
<br /> AND EMPLOYERS'LIABILITY
<br /> 13 ANY�f 0855104632 01/0112018 011011201'8 E.L EACH ACCIDENT S 1,000,00 ,
<br /> OFFJCERIMEMSER EXCLUDED? ❑ NIA - -"
<br /> (Mandatory In NH) E.L.DISEASE.EA EMPLOYEE s 1,000,00
<br /> If as,descr be urider
<br /> DSCRIPTIONOFOPERATIONSbelow E,LDISEASE-POLICY LIMIT S 1,000,00
<br /> A Installation Q37-01 52886 01/0112018 01/0/12019 75,00
<br /> Floater I deduct 50
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES;Attach ACORD 101,Additional Remarks Schedule,IF more space Is required)
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 8EFORE
<br /> Orange County
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Or nge County WITH THE POLICY PROVISIONS.
<br /> Hillsborough, NC 27278 j
<br /> AUTHORIZED REPRESENTATIVE ,
<br /> 1
<br /> i
<br /> Q 1988-2009 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD
<br />
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