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DocuSign Envelope ID : 5004353C- 17AB-4010-9OB4- B1COAE44672A <br /> i <br /> t� i .� ` c � � il� a7 � I� MNVE DA� E15S1zte (MMtt5U1YY'l <br /> . . IErie GERTIFIC A 1�f <br /> insurance° '� THIS CERTIFICATE iS iSS1.0 AS A MATTER OF iNFORMAT10Ni ONLY <br /> i Icme (f x e • I Ob _ re imiurame Place , 1d r� ! Pit, ^ <br /> ' iI ire 1 8 ; #,458 CS • Fa)> 81 4 ,3:O 3126 • wvnw e eieinsurance col i <br /> III III III AGENT'S N0, . <br /> NAME AND ADDRESS OFAGENCY BAREFOiDT �3c YOUNG IN GRCTLI [' t . � l;Q „�, �§ ,� _ <br /> S�i" A `+� 1 . JJ 157h ^p • 0 ED1�. 1NSli3iANE PR01' ! Y -CxJt r>f G� tPA ('r <br /> 61 N I Flat Applicabial <br /> Go ; E C it IPI RA E }�DHA� II�L J <br /> KN1Crt-f 'i" 1 .► AII NC: � 754 : -19506 r c In Orrtnity r O.. iAtiarruy lift, act , in ti4Y <br /> Go Y_ . >' � <br /> s ' <br /> n 19 ) 217 - !, 87i) ' _ „ This certificate is issued for InforniaPionputposes only and confers <br /> � " no ri hts on the certificate holder. It dogs not affirmatively or <br /> NAME AND ADDRESS OF NAMED INSURED negatively amend, extend , or otlierwise after the terms, exclusions <br /> Axis Construction Man <I crl�ent i and conditions of insurance coveral a contained in the s) govern <br /> indicated belom The terms and cond �lions of the policy(ies) govern <br /> IN ( the insurance coverage as applied 10 any given situation • Limits <br /> shown may have been roduced by claims paid, This certificate of <br /> 33Uti purhau� Chapel IIiU s insurance does not constitute: a I,nntrart between the issuing <br /> ' lnsurer ( s ► , authorized representative or producer and the <br /> Durhai» , Nt ' 27707 j cerl licit holder, <br /> i <br /> into sect' that lictes , as indicated by the ! o cyJUW ler b f;lou,x aro I_n- force fpr the Named �sured at the time thai tt e Ce�ificate is . t)�� ed <br /> �g i'� u <br /> {T��hy}is pp{���I�,, <br /> LTIII S G iYPF OF INSURANCE ,_ T _ POLVY NUMBEH� I�Q�� -.._L1nT <br /> EACH OCCURRENCE S_ <br /> GENERAL LIABILITY I ( 1 1 / 14 1 1 1 ? I / 1 S FIRE DAMAGE (A IS! <br /> Prey ; 5 <br /> l : (� 1 Q 33 U 122f} 6i �� I ( ► ItLIIII t <br /> i � COMMERCIAL GENERAL LIABILITY ) ` MEQtP ¢Mt 7ne Fsanx'; <br /> CLAIMS MADE OCCUR PERSONAL d ADV*INJURY1 I ill I(l .il{ I :) <br /> GENERN_ A66HGGATh s <br /> _ PRODUCTS-c0I4tPtOP AGGi 5 _ <br /> GEN't AGGREGATL LIMIT APPUES PER: <br /> POLICY PRO.IEM LOG <br /> BODILY INJURY ' <br /> AUTOMOBILE LIABILITY (EACH PERSON) j $a <br /> j (OWNED HIRED, <br /> N INJURY <br /> 1 <br /> "ANYAUTD ' I IIACfFNT 5 ON 01UNEb) <br /> _ OWNED ! I PROPERTY DAMAGES <br /> HIRED BODILY INJURY AND j <br /> { � NON-OWNED PRD COMN AGE <br /> COMBINED <br /> _ <br /> iS <br /> 6.. ] GARAGE <br /> EACH ocGuQRFNCF S._ It <br /> ( EXCESS LIABILITY i <br /> ] OCCURRENCE AGGfiT:G11TE �_ a _ _ -. <br /> p <br /> i <br /> RETENTION $ <br /> WORKERS COMPENSATION R Qy 5 q i ( 1223 1# �1 ` iI .' I I BODILY ACCIDENT S 1 ( 1Gd) ,G00 EACH ACCIDENT <br /> EMPLOYERS LIABILITYINJURY DISEASE S 1 S )CIO .C'Qt} F'I)UCY lJM(T <br /> a <br /> RY DISEASE S 1 1 )00,(400 VACH PMPLOYEE <br /> OTHER <br /> OESCRiPTtON OF OPERATIONSROCATIDNSryENICLESIEXGLUSIONS ADDEO RY ENDORSEh4ENT/SPECIAL PROVISIONS <br /> i <br /> CANCELLATION : SHOULD ANY OF THE ABOVE DESCRI <br /> BED POLICIES BE ACAG POLICIES BEFORETHE EXPIRATION DATE I HEREOF, NOTICE WILL BE I) EI IV - <br /> ERED IN ACCORDANCE WITH THE POLICY PROVISIONSIN - -- <br /> iMpORTpNT; If the certificate holder is an ADDITIONAL INSUROv the Volicy(ies) must be endorsed . If SUBROG JIGId iS WAIVED, subject III the <br /> terms and conditions of the pOlicy, certain pollens may require an (endorsement. A statement on tlu :1 cortiticate fines not canter <br /> rights to the cerHficate holder in lieu of such end6rsement(S) <br /> NAME AND ADDRESS OF cERTI >r are HOLDER ` <br /> ( ) r<lljoe ( 4iginLy Govenrl_ient <br /> I nuTu )sizrn RE PRtSE;AI•rA1tY# <br /> PO Box 8181 <br /> I Illisborough , New 2727r• <br /> Page 1 of 1 <br /> CIGb23Cl $it 1 <br />