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r UAI t(MM/UU/YYYY) <br /> AL oRV CERTIFICATE OF LIABILITY INSURANCE 11/2/2014 <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 endorsement(s). <br /> PRODUCER NAME: J. DAVID BALLARD <br /> BALLARD AGENCY INC HONE Ext: (919) 732-2158 FAX A/C.No 919)732-963E <br /> PO BOX 1559 E-MAIL <br /> ADDRESS:ballard @ ball ardagencyinc.com <br /> Hillsborough, NC 2727 INSURER(S) AFFORDING COVERAGE NAIC1$ <br /> INSURER A.VOLUNTEER SAFETY WORXERS COMPENSATION FUND <br /> INSURED CALDWELL FIRE DEPARTMENT, INC. INSURER B: <br /> 7020 GUESS RD INSURER C <br /> ROUGEMONT, NC 275572 INSURER D: <br /> INSURER E <br /> INSURER F <br /> COVERAGES CERTIFICATE NUMBER: 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 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 /> INSR ADDL SUBR P0U Y EFF Y EXP <br /> LTR TYPE OF INSURANCE INSD wvD POLICY NUMBER MM/DD/YYYY MM/DDMYY LIMITS <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ <br /> CLAIMS-MADE C OCCUR PREMISES Ea occurrence $ <br /> MED EXP(Any one person) $ <br /> PERSONAL&ADV INJURY $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ <br /> POLICY CI PRO- LOC _ <br /> JECT L_� PRODUCTS-COMP/OP AGG $ <br /> $ <br /> OTHER SINGLE I I $AUTOMOBILE LIABILITY Ea accident <br /> ANYAUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ <br /> Per accident AUTOS $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION X I PER <br /> H- <br /> AND EMPLOYERS'LIABILITY STATUTE ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE IY/NN 911-166-0 7/1/13 7/1/14 E.L.EACH ACCIDENT $ 100,000 <br /> A OFFICER/MEMBER EXCLUDED? I1V N/'4 <br /> (Mandatory in NH) I— E.L. DISEASE-EA EMPLOYE J.$ 100,000 <br /> j If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 <br /> I <br /> I <br /> I <br /> DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> I <br /> I <br /> CERTIFICATE HOLDER CANCELLATION <br /> I <br /> ORANGE COUNTY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> PO BOX 8181 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> HILLSBOROUGH, NC 27278 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> ©1988-2013 ACORD CORPORATION. All rights reserved. <br /> ACORD25(2013104) The ACORD name and logo are registered marks of ACORD <br />