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DocuSign Envelope ID: E7280C15-9FB3-4lA8-848B-04166A2932E2 <br /> AC40 0 /06 CERTIFICATE OF LIABILITY INSURANCE DAT5/06/D/2019D/YYYY) <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DOES NOr 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 have ADDITIONAL INSURED provisions or be endorsed. <br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A;statement on <br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT Christy Freeman <br /> Chapel Hill office PHONE 919-933 4000 AIC No}. <br /> I FAX 919-933 5150 <br /> (A/C,No,Ext): _ L <br /> 1289 Fordham Blvd Ste D-1 ADDE-MRESS: freemc5camalionwide.com <br /> INSURERS)AFFORDING COVERAGE NAIC <br /> Chapel Hill NC 27514-6110 INSURER A Builders Mutual Insurance Company <br /> INSURED INSURER 8 <br /> Harold Summey Jr INSURER C <br /> 2805 Miller Rd INSURER D <br /> INSURER E <br /> Hillsborough NC 27218-8487 INSURER <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' --- - - POLICY EFF POLICY EXP-- LIMITS <br /> LTR TYPE OF INSURANCE POLICYNUMBER MMIDD/YYYV MM/DD/YYYY <br /> COMMERCIAL GENERAL LIABILITY _EACH OCCURRENCE $ <br /> DAMAGE TO RENTED - <br /> _,]CLAIMS-MADE OCCUR i PREMISES fEa occurrence) <br /> MED EXP(Any no person)_ $ <br /> PERSONAL&ADV INJURY $ <br /> GEN L AGGREGATE LIMIT APF LIES PER GENERAL AGGREGATE $ <br /> P POLICY[ _l ELT _I LOC I I PRODUCTS-COMP/OPAGG $- <br /> OTHER: I $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> _(Ea accident) <br /> ANY AUTO AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED <br /> AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ <br /> —- - <br /> HIRED NON-OWNED <br /> PROPERTY DAMAGE $ <br /> AUTOS ONLY __. AJTOS ONLY _(Per acadenl) <br /> UMBRELLA LIAB EACH OCCURRENCE $ <br /> EXCESS LIAB FCR I$ <br /> ..--- -------' --- ---- <br /> S MADEi AGGREGATF <br /> � I, <br /> DED RETENTION 6 _ $ <br /> WORKERS COMPENSATION '. � I X PER OTH- <br /> STATU rE ER <br /> AND EMPLOYERS'LIABILITYA (Mandatory In NH Y NIA E.L EACH ACCIDENT $ 100,000 <br /> AFFICE /MEMB REXCLUDED?-CUTIVE Q7/21/2C1t3 O7/21/2019 -- - - --- --- ---- -- <br /> _ Y f_N j <br /> OFFICER/MEMBEREXCLUDED � � BII238289 <br /> E.L.DISEASE__EA EMPLOYEE $ 100,000 <br /> If yes,describe under - <br /> DESCRIPTION OF OPERATION i below E.L.DISEASE-POLICY LIMIT $ 500,000 <br /> DESCRIPTION OF OPERATIONS I LO,:ATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> Orange County Governmen SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> PO Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Hillsborough NC 27278 AUTHORIZED REPRESENTATIVE <br /> Christy I reeman <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />