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DocuSign Envelope ID: D4966361-0983-4ABD-B54D-70D58DB5C632 <br /> r IErie CERTIFICATE OF INSURANCE <br /> I lnsuranae -THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY- <br /> 100 Erie Ins.I'1. • Erie.PA 16530 CERTIFICATE HOLDER COPY <br /> NAME AND NUMBER OF AGENCY DATE ISSUED 02/19/2018 <br /> THE SORGI INSURANCE AGENCY INC JJ 1095 <br /> 16 CONSULTANT PL STE 102 NAME AND ADDRESS OF CERTIFICATE HOLDER <br /> DURHAM, NC 27707-6313 919-682-4814 <br /> NAME AND ADDRESS OF NAMED INSURED <br /> ORANGE COUNTY <br /> TRIANGLE LANDSCAPING INC * PO BOX 8181 <br /> PO BOX 144 HILLSBOROUGH NC 27278— <br /> STEM NC 27581-0144 <br /> This is to certify that policies,as indicated by Policy Number below,are in force for the Named Insured at the time that the certificate is being issued. <br /> � F> .......... <br /> "- •>. .ROIL ?f.:AI� a£ ::i::i::;:::.::.::.::.::.::::::::::";-:::::";:-;:-;:-"........:�-----,".:..:.....; .;;:�5:�5:•;;:•>:•>;;;;;;. '':5:•>:•>• <br /> GENERAL LIABILITY Q272620479 03/26/2018 03/2612019 EACH OCCURRENCE S "'' <br /> COMMERCIAL GENERAL LIABILITY 100fl000 <br /> OCCURRENCE FORM FIRE DAMAGE <br /> G EN'L AGGREGATE LIMIT APPLIES [Any oneprernises) $ 1000000 <br /> PER:POLICY <br /> VOLUNTARY PROPERTY DAMAGE MED EXP(Any one person) S E7flfl0 <br /> II' #I:jx <br /> PERSONAL&ADV INJURY S 1 000000 <br /> GENERAL AGGREGATE S 2000000 <br /> PRODUCTS-COMPIOP AGG S 2000000 <;,;;.'•: <br /> 6:BODILY INJURY <br /> 3: <br /> AUTOMOBILE LIABILITY Q032630379 03/26/2018 03/26/2019 (EACH PERSON) X. <br /> ANY AUTO(OWNED,HIRED, BODILY INJURY <br /> NON-OWNED) EACH ACCIDEN <br /> PROPERTY DAMAGE S <br /> BODILY INJURY AND � <br /> PROPERTY DAMAGE 750000 \ <br /> COMBINED - <br /> EACH OCCURRENCE ...............: ........ <br /> : 5's:. <br /> AGGREGATE -------------- <br /> STATUTORY <br /> WORKERS COMPENSATION Q872600559 03/26/2018 0312612019 �.... <br /> AND BODILY ACCIDENT S 500000 EACH ACCIDENT <br /> EMPLOYERS LIABILITY INJURY DISEASE S 500000 POLICY LIMIT <br /> BY DISEASE t 500000 EACH EMPLOYEE <br /> DESCRIPTION OF OPERA'IONS/LOCATIONSIVEHICLES/E iCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS <br /> CANCELLATION:SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE <br /> DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. <br /> IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terns and <br /> conditions of the policy,Certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such <br /> endorsement(s). <br /> THIS CERTIFICATE IS ISSUED FOR INFORMATION PURPOSES ONLY AND ERIE INSURANCE <br /> CONFERS NO RIGHTS ON THE CERTIFICATE HOLDER.IT DOES NOT <br /> AFFIRMATIVELY OR NEGATIVELY LIST,AMEND,EXTEND OR OTHERWISE <br /> ALTER THE TERMS,EXCLUSIONS AND CONDITIONS OF INSURANCE <br /> COVERAGE CONTAINED IN THE POLICY(IES)INDICATED ABOVE.THE TERMS SEE REVERSE SIDE <br /> AND CONDITIONS OF THE POLICY(IES)GOVERN THE INSURANCE COVERAGE <br /> AS APPLIED TO ANY GIVEN SITUATION.LIMITS SHOWN MAY HAVE BEEN <br /> REDUCED BY CLAIMS PAID.THIS CERTIFICATE OF INSURANCE DOES NOT <br /> CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS),AUTHORIZED , <br /> REPRESENTATIVE OR PRODUCER AND CERTIFICATE HOLDER. AUTHORIZED <br /> OF-1668 09112 CIF REPRESENTATIVE <br />