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DocuSign Envelope ID:AC67BBAB-C829-4786-8FAF-2342D3D69B6C <br /> Erie CERTIFICATE OF INSURANCE <br /> �e' Insurance' -THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY- <br /> 100 Erie Ins.PI.• Erie,PA 16530 CERTIFICATE HOLDER COPY <br /> NAME AND NUMBER OF AGENCY DATE ISSUED 0211912❑19 <br /> THE SOROI INSURANCE AGENCY MC JJ1095 <br /> 16 CONSULTANT PL STE 102 NAME AND ADDRESS OF CERTIFICATE HOLDER <br /> OUSHAM, NC 27707-6313 919-682-4814 <br /> NAME AND ADDRESS OF NAMED INSURED <br /> ORANGE COUNTY <br /> TRIANGLE LANDSCAPING INC 19 <br /> �O Box s i 11 <br /> PO BOX 144 HILLSBOROUGH NC 27278- <br /> STEM NC 27581-0144 <br /> Thls is to certify that pallcles,as indicated by Policy Number below,are in force for the Named Insured at the time that the certificate is being Issued. <br /> .........."........ <br /> F fF <br /> .�xY;:: . .. ..""""........................ «.;:>:::=:= :=>: <br /> GE: .....:-;:-;:F f>k`tH IVIaER: -------------. >3pp <br /> i5i5A ."-------------------------------------------- ---------."... y�!�,y�y�/{-�!,�� <br /> -:�lFLIVH:fil!t4L: •ff� / /"i -------------- <br /> :..... """""...."...".....""" """"""""""""""""""N.0-1..."."""""". ." .............""""""""""""""........... ---------------------------------- <br /> GENERAL LIABILITY Q272620479 03/2612019 03/26/2020 EACH OCCUR HENCE S 1000040 <br /> COMMERCIAL GENERAL LJABI LITY <br /> OCCURRENCE FORM FIRE DAMAGE <br /> GEN'L AGGREGATE LIMIT APPLIES (Any ane premises) 1000000 - <br /> PER:PROJECT <br /> M E D E X P(Any on person) S <br /> 500❑ <br /> PERSONAL B ADV INJURY $ <br /> 1000000 <br /> GENERALAGGREGATE $ <br /> 2000000 ;:= <br /> PRODUCTS-COMP1OP AGG S <br /> 2000000 <br /> BODILY INJURY <br /> AUTOMOBILE LIABILITY 0032630379 0312612C19 03/26/2020 S <br /> EACH PERSON) <br /> 1 <br /> ANY AUTO{OWNED,HIRED, BODILY INJURY <br /> a <br /> NON-OWNED} EACH IDEN <br /> P ROPE RTY DAMAGE $ <br /> BODILY INJURY AND <br /> s 75000❑ <br /> PROPERTY DAMAGE <br /> COMBINED <br /> ,�• <br /> •'OFF•'FFr�FF:; <br /> EACH OCCURRENCE <br /> --------------- <br /> �F F•�/.� , <br /> { <br /> ----------------- <br /> AGGREGATE <br /> STATUTORY <br /> I'•`:••:'•'•: - _='--><> <br /> WORKERS COMPENSATION Q872600559 03/26/2019 03/26/2020 '''•>>' /FI,.'•FF�� ��;�:=>_ <br /> AND BODILY ACCIDENT $ 500000 EACH ACCIDENT <br /> EMPLOYERS LIABILITY INJURY DISEASE $ 500000 POLICY LIMIT <br /> BY DISEASE $ 500000 500000 EACH EMPLOYEE <br /> DESCRIPTION OF OPERATiONSILOCATIONSIVEHICLES/EXCLUSIONS 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 POLICYtIES)GOVERN THE INSURANCE COVERAGE <br /> AS APPLIED TO ANY GIVEN SITUATION.LIMITS SHOWN MAY HAVE BEEN <br /> REDUCED BY CLAIMS PAID,THIS CEF171FICATE OF INSURANCE DOES NOT <br /> CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED , <br /> REPRESENTATIVE OR PRODUCER AND CERTIFICATE HOLDER. AUTHORIZED <br /> OF-1568 09112 CIF REPRESENTATIVE Ate, 4�� <br />