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DocuSign Envelope ID:321E16A8-FDB9-4A79-AA3C-51D3867DBOEO <br /> Erie CERTIFICATE OF INSURANCE <br /> �� lrsuranae -THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY- <br /> 1D0 Erie Ins.PI. • Ene,PA 16530 CERTIFICATE HOLDER COPY <br /> NAME AND NUMBER OF AGENCY DATE ISSUED 06/05/2018 <br /> G SUGGS INSURANCE AGENCY HNC JJ1262 <br /> 1025 5U4LARD C7 STE 205 NAME AND ADDRESS OF CERTIFICATE HOLDER <br /> RALEIGH, NC 27615—$874 919-875-8889 <br /> NAME AND ADDRESS OF NAMED INSURED <br /> ORANGE COUNTY <br /> ADVANCED SEALCOATING INC PO BOX Biel <br /> 8804 ERINSBROCK OR HILLSBOROUGH NC 27278— <br /> RALEIGH NC 27617-8342 <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 F <br /> :-;:;:;•s:•s:.;..;.---;r:-;;,..;..7YR�: SI:iTi $Ff3 :a:::�=:=:=i:=:=iP��:i ': '•;;;•...:...,..... y �-- -:/s•;;;;;;;;;;;;;;;;:4•. <br /> L=]EPIRATI iWM•F / <br /> .............. <br /> GENERAL LIABILITY Q301320797 06/13/2018 06/13/2019 <br /> EACH OCCURRENCE $ 1 DQDDDD <br /> COMMERCIAL GENERAL L IA BI LITY <br /> OCCURRENCE FORM FIRE DAMAGE <br /> G EN'L AGGREGATE tJ M IT APPLIES [Any one premisas] <br /> 100DDOD <br /> PER:PROJECT <br /> VOLUNTARY PROPERTY DAMAGE MED EXP[Any one person] S <br /> faDOD <br /> PERSONAL&ADV INJURY $ "s" :==:>::I:I:I:I:I:I:I:I:I.... <br /> 100DDDD <br /> GENERAL AGGRE GATE S 2000000 <br /> >........... :1:1:1....... <br /> .. <br /> PRODUCTS-COMPIOP AGG S 2000000 ---- <br /> AUTOMOBILE LIABILITY Q060930587 0E10912018 0610912019 BODILY INJURY $ <br /> [EACH PERSON] i< >::::>::::::: <br /> OWNED BODILY INJURY :1>............III .. <br /> (EACH ACCIDENT) S <br /> PROPERTY DAMAGE S <br /> .....I:I:I:I:I:I:I:I.....=:=> <br /> BODILY INJURY AND j <br /> PROPERTY DAMAGE S 1000000 <br /> C.................... <br /> COMBINED <br /> EXCESS LIABILITY 0301370134 06/13/2018 06/13/2019 EACH OCCURRENCE 1 D00D0D `' <br /> OCCURRENCE FORM <br /> AGGREGATE 1000000 <br /> WORKERS COMPENSATION 0901300546 06/13/2018 06/13/20 i 9 STATUTORY >:•>.•;��<• <br /> AND BODILY ACCIDENT $ 600000 EACH ACCIDENT <br /> EMPLOYERS LIABILITY INJURY DISEASE S 500000 POLICY LIMIT <br /> BY DISEASE $ 5DDD00 EACH EMPLOYEE <br /> I <br /> DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIEXCLUSIONS 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.It SUBROGATION IS WAIVED,subject to the terms 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 INSURER(S),AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER AND CERTIFICATE HOLDER. AUTHORIZED <br /> REPRESENTATIVE__ <br />