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DocuSign Envelope ID: D44FBOEB-DA34-4A73-A73D-3D95E1AE8OA2 <br /> �1Erie CERTIFICATE OF INSURANCE DATE ISSUED(MM/DD/YY) <br /> .3 1 nsuranaf —THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY— 2/11/21 <br /> Home Office • 100 Erie Insurance Place - Erie,Pennsylvania 16530 • 814,870.2000 <br /> Toll free 1.800.458,0811 • Fax 814,870.3126 • www.erieinsurance.com <br /> NAME AND ADDRESS OF AGENCY THE BALLARD AGENCY AGENT'S NO. <br /> NY <br /> 105 W KING ST M1010 N E A <br /> HILLSBOROUGH NC 27278-2545 Co.:E �RIE INSURANC %RANGE. lNotApplicable <br /> Hie Indemnl o. ttorne -In-Fact\\ in NY <br /> (919)732-2158 This certificate is issued for information purposes only and confers <br /> NAME AND ADDRESS OF NAMED INSURED no rights on the certificate holder. It does not affirmatively or <br /> negatively amend,extend,or otherwise alter the terms,exclusions <br /> The Historical Foundation of and conditions of insurance coverage contained in the policy(ies) <br /> 201 N.Churton St. indicated below.The terms and conditions of the policy(ies)govern <br /> the insurance coverage as applied to any given situation.Limits <br /> Hillsborough,NC 27278 shown may have been reduced by claims paid.This certificate of <br /> insurance does not constitute a contract between the issuing <br /> insurer(s), authorized representative or producer and the <br /> certificate holder. <br /> This is to certiN that policies,as indicated by the Policy Number below,are in force for the Named Insured at the time that the Certificate is being issued. <br /> LTR co d'i TYPE OF INSURANCE i0 _' PONY NUMBER ` LIMITSAM Inald <br /> E ®GENERAL LIABILITY CH OCCURRENC 1,000,000 <br /> Q44 2250193 8/22/20 8/22/21 " <br /> ❑X COMMERCIAL GENERAL LIABILITY FIREDAMAGE_(AnyOrire 1 000000 <br /> ❑CLAIMS MADE ©OCCUR EXP(Any One Pelsons 5,000 <br /> ❑ PERSONAL&ADV.INJURY 1,000,000 � <br /> ❑ GENERAL AGGREGATE S 2,000,000 <br /> GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS-COMP/OPAGG 2,000,000 <br /> ®POLICY ❑PROJECT ❑LOG <br /> ❑ AUTOMOBILE LIABILITY RODILYINJURY i <br /> ❑ "ANYAUTO°(NON HIRED <br /> {EACH PER $ 1 <br /> 80DILYINJURY ^/ <br /> ❑OWNED ,,E CHACCI EU, $ � <br /> ❑ HIRED 00 <br /> PROPERTY DAMAGE = $ ; <br /> ❑NON-OWNED '\"BODfLYINJURYAND <br /> PROPERTY DAMAGE <br /> ❑GARAGE COMBINED $ <br /> EXCESS LIABILITY 1 <br /> ❑ � EACH�OCCURRENC _.�$Ir � <br /> ❑OCCURRENCE PWAGGREGATE W$ <br /> $ <br /> ❑RETENTION $ $ <br /> a A <br /> WORKERS COMPENSATION& <br /> - � .. L% C\ <br /> EMPLOYERS LIABILITY BODILY ACCIDENT $ EACH ACCIDENT <br /> INJURY, DISEASE $ POLICY LIMIT <br /> BY DISEASE $ EACH EMPLOYEE <br /> OTHER <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br /> CANCELLATION: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIV- <br /> ERED 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 <br /> terms and conditions of the policy,certain policies may require an endorsement,A statement on this certificate does not confer <br /> rights to the certificate holder in lieu of such endorsement(s). <br /> NAME AND ADDRESS OF CERTIFICATE HOLDER <br /> Orange County AUTH IZED REPRESENTATIVE <br /> PO BOX 8181 <br /> Hillsborough,NC 27278 <br /> EIG6230 8/11 <br /> Page 1 of 2 <br />