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DocuSign Envelope ID:05AC53B6-D6A8-4C58-AE61-C86lC28D8998 <br /> 141 <br /> Erie CERTIFICATE OF INSURANCEI nsurancE� —THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY— <br /> Hane Office - 100 Erie insurance Place • Erie,Pennsylvania I E53o • 814.870,2000 <br /> Tail free 1.800.458.0811 - Fax 614,870,3126 - www.eriehvslrrance,com <br /> NAME AND ADDRESS OF AGEWY THE BALI.ARI)AGENCY AGENT'S NO <br /> 105 W KING ST J31010 <br /> HILLSBOROUGH,NC 27278-2543 Go..E E �SURANC&ICHANGE o pp c e <br /> r e In emnl ttorn -in-Fact in My <br /> (919)732-2158 This certificate is issued for information purposes on and confers <br /> NAME ANDADDR I no rights on the certificate holder. It does net affirmatively or <br /> negatively amend,extend,or otherwise altar the terms,eYciusions <br /> HILISBOROUGH ART'S COUNCIL and conditions of insurance coverage contained In the policypes) <br /> 102 N.CHURTON ST. indicated below.The terms and conditions of the policy(les)govern <br /> the Insurance coverage as applied to any given situation.Limits <br /> HM SBOROUGH,NC 27278 shown may have been reduced by claims paid,This certificate of <br /> insurance does not constitute a contract between the Issuing <br /> insprer(s), authorized representative or producer 141 tAe <br /> certlflcate holder. <br /> This is to cen that policies,as Indleated the Polq Number below,are In force for the coed Insured at the time that the Certificate is beina issued. <br /> TYPE OF INSURANCE P UCY BEj LIMITS <br /> E ®GENERAL LIABILITY EAGH OCCURRENCE 1000 U00 <br /> ®COMMERCIAL GENERALLIABILfTY 032 1000580 1 8/10/19 8/10i20 <br /> ❑CLNMS MADE ®OCg1 FIRE DAMAGE Ai Ono FIre 1,000,00() <br /> MED EAP Cie Prison 5,000 <br /> ❑ PERSONAL 8 ADV.INJURY 1000 000 <br /> ❑ GENERALAGGREGATE 2,000, <br /> 000 <br /> GEN'LAGGREGATE UMfTAPPUEs PER PRODUCTS-COMP/01RAGG 2 OW 000 <br /> IER POUCr ❑PROJECT ❑LAC <br /> AUTOMOBILE LIABILITY BODILYINJURY <br /> ❑"ANYAUTO"(NON OWNlED)° (EACHPfRSON) 5 <br /> ❑OWNED BODILYCICNJJllURRY S <br /> ❑HIRED PROPERTYDAMAGE Is <br /> ❑NON-OWNED BCDILYINJURVAND <br /> ❑GARAGE PROPERTYOAAMGE f s <br /> COMBINED <br /> EXCESS LIABILITY EACHOGCURAENCE S <br /> El OCCURRENCE .AGGREGATE Is <br /> ❑RETENTION S s <br /> s <br /> i - <br /> E WORKERS COMPENSATION& <br /> EMPLOYERS LIABILITY Q85 1800607 1/18/20 1/18/21 BODILY] ACCIDENT S 5OC,O00 EACH ACCIDENT <br /> INJURY! DISEASE $ 500,000 PoUCYUNiT <br /> OTHER BY ' DISEASE $ 500,000 FACH EMPLOYEE <br /> i <br /> i <br /> I <br /> DESCRIPTION OF OPERATIONSILDCATIONS/VERICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br /> CANCELLATIDIII: 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 /> germs and conditions of the policy,certain policies may require an endorsement A statement on this certificate dDes not confer <br /> rights to the certificate holder in lieu of such endorsement(s), <br /> NAME AND ADDRESS OF CERTIFICATE HOLDER <br /> ORANGE COUNTY AUTHOAM REPRESUMTNE <br /> PO BOX 8181 <br /> HILLSBOROUGH,NC 27278 <br /> EIG6230 Bill <br /> Page i of t <br />