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DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE <br />THISCERTIFICATEISISSUEDASAMATTEROFINFORMATIONONLYANDCONFERSNORIGHTSUPONTHECERTIFICATEHOLDER.THIS <br />CERTIFICATEDOESNOTAFFIRMATIVELYORNEGATIVELYAMEND,EXTENDORALTERTHECOVERAGEAFFORDEDBYTHEPOLICIES <br />BELOW.THISCERTIFICATEOFINSURANCEDOESNOTCONSTITUTEACONTRACTBETWEENTHEISSUINGINSURER(S),AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT:IfthecertificateholderisanADDITIONALINSURED,thepolicy(ies)mustbeendorsed.IfSUBROGATIONISWAIVED,subjectto <br />thetermsandconditionsofthepolicy,certainpoliciesmayrequireanendorsement.Astatementonthiscertificatedoesnotconferrightstothe <br />certificate holder in lieu of such endorsement(s). <br />CONTACTPRODUCERNAME: <br />FAXPHONE(A/C, No):(A/C, No, Ext): <br />E-MAILADDRESS: <br />INSURER(S) AFFORDING COVERAGENAIC # <br />INSURER A : <br />INSURED INSURER B : <br />INSURER C : <br />INSURER D : <br />INSURER E : <br />INSURER F : <br />COVERAGESCERTIFICATE NUMBER:REVISION NUMBER: <br />THISISTOCERTIFYTHATTHEPOLICIESOFINSURANCELISTEDBELOWHAVEBEENISSUEDTOTHEINSUREDNAMEDABOVEFORTHEPOLICYPERIOD <br />INDICATED.NOTWITHSTANDINGANYREQUIREMENT,TERMORCONDITIONOFANYCONTRACTOROTHERDOCUMENTWITHRESPECTTOWHICHTHIS <br />CERTIFICATEMAYBEISSUEDORMAYPERTAIN,THEINSURANCEAFFORDEDBYTHEPOLICIESDESCRIBEDHEREINISSUBJECTTOALLTHETERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />ADDLSUBRINSR POLICY EFFPOLICY EXPTYPE OF INSURANCE LIMITSPOLICY NUMBERLTR (MM/DD/YYYY)(MM/DD/YYYY)INSDWVD <br />COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE$ <br />DAMAGE TO RENTEDCLAIMS-MADEOCCUR $PREMISES (Ea occurrence) <br />MED EXP (Any one person)$ <br />PERSONAL & ADV INJURY$ <br />GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ <br />PRO-POLICYLOC PRODUCTS - COMP/OP AGG$JECT <br />$OTHER: <br />COMBINED SINGLE LIMITAUTOMOBILE LIABILITY $(Ea accident) <br />BODILY INJURY (Per person)$ANY AUTO <br />ALL OWNEDSCHEDULED BODILY INJURY (Per accident)$AUTOSAUTOSNON-OWNED PROPERTY DAMAGE $HIRED AUTOS (Per accident)AUTOS <br />$ <br />UMBRELLA LIAB EACH OCCURRENCE$OCCUR <br />EXCESS LIAB CLAIMS-MADE AGGREGATE$ <br />$DEDRETENTION$ <br />PEROTH-WORKERS COMPENSATION STATUTEERAND EMPLOYERS' LIABILITY Y / NANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT$N / AOFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH)E.L. DISEASE - EA EMPLOYEE$ <br />If yes, describe under E.L. DISEASE - POLICY LIMIT$DESCRIPTION OF OPERATIONS below <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />CERTIFICATE HOLDERCANCELLATION <br />SHOULDANYOFTHEABOVEDESCRIBEDPOLICIESBECANCELLEDBEFORE <br />THEEXPIRATIONDATETHEREOF,NOTICEWILLBEDELIVEREDIN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />© 1988-2014 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORDACORD 25 (2014/01) <br />BISHOP1OP ID: SF <br />08/22/2014 <br />Tara J. SmithwickFirst Insurance Services, Inc. <br />P. O. Box 13687RTP, NC 27709Sandy B. Fisher <br />919-941-0549919-941-0135 <br />Selective Insurance Company12572 <br />Builders Mutual Insurance Co10844WL Bishop Construction Co <br />2211 Leah Road <br />Hillsborough, NC 27278 <br />AX 1,000,000 <br />X X S 199192109/04/201409/04/2015 500,000 <br />10,000 <br />1,000,000 <br />3,000,000 <br />X 3,000,000 <br />1,000,000 <br />AX X S 199192109/04/201409/04/2015 <br />XX <br />XX 5,000,000 <br />A S 199192109/04/201409/04/2015 5,000,000 <br />0X <br />X <br />B WCP1020372 EXCLUDE09/04/201409/04/2015 1,000,000YMIKE & WILLIAM BISHOP 1,000,000 <br />1,000,000 <br />A Contractors EquipS 199192109/04/201409/04/2015 Limit75,000 <br />Leased/Rented Deductibl1,000 <br />County of Orange Financial Services is additional insured for General <br />Liability and Auto Liability if required by written/executed contract, <br />before a loss. Cancellation notice applies per the attached IL0269 0908. <br />ORANGE4 <br />County of Orange <br />Financial Services <br />PO Box 8181 <br />Hillsborough, NC 27278 <br />DocuSign Envelope ID: 21BF91F6-B248-4D42-BB0F-0B51048AC927