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DocuSign�elope ID:35B29A4C-EA5E-4F1C-9C55-5AB9721304BD 1 OP ID: NJE <br /> A`164 ��o CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) <br /> 04/08/2020 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DOES NOT 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 be endorsed. If SUBROGATION IS WAIVED, subject to <br /> the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTNAME: Natalie Engelhart <br /> The Sorg!Insurance Agency PHONE FAX <br /> 16 Consultant Place Suite 102 Insurance <br /> No Ext:919-682-4814 AIc,No): 919-682-4906 <br /> Durham, NC 27707 E-M-ADDRESS: natalie@sorgiinsurance.com <br /> James E.Sorgi,CIC PRODUCER TRIALAN <br /> CUSTOMER ID#: <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURED Triangle Landscaping Inc. INSURER A:Erie Insurance Exchange 26271 <br /> Brad Lewis dba <br /> INSURER B <br /> P O Box 144 <br /> Stem, NC 27581 INSURER C: <br /> INSURER D: <br /> INSURER E: <br /> INSURER F: <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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS <br /> LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 <br /> A X COMMERCIAL GENERAL LIABILITY Q2726204479 03/26/2020 03/26/2021 DAMAGE TO RENTED 1,000,00 <br /> PREMISES Ea occurrence $ <br /> CLAIMS-MADE � OCCUR MED EXP(Any one person) $ 5,00 <br /> PERSONAL&ADV INJURY $ 1,000,00 <br /> GENERAL AGGREGATE $ 2,000,00 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 <br /> X POLICY JEC T PRO- LOG $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 750,000 <br /> (Ea accident) <br /> A ANY AUTO Q032630379 03/26/2020 03/26/2021 BODILY INJURY(Per person) $ <br /> ALL OWNED AUTOS BODILY INJURY(Per accident) $ <br /> X SCHEDULED AUTOS PROPERTY DAMAGE $ <br /> HIRED AUTOS (PER ACCIDENT) <br /> NON-OWNED AUTOS $ <br /> $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DEDUCTIBLE $ <br /> RETENTION $ $ <br /> WORKERS COMPENSATION X WC STATU- OTH- <br /> AND EMPLOYERS'LIABILITY TOR,LIMITS ER <br /> A ANY PROPRIETOR/PARTNER/EXECUTIVE YIN Q872600559 03/26/2020 03/26/2021 E.L.EACH ACCIDENT $ 500,00 <br /> OFFICER/MEMBER EXCLUDED? ❑Y N/A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,00 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 <br /> . I � 1 7 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) <br /> email to: abarnes@orangecountync.gov <br /> CERTIFICATE HOLDER CANCELLATION <br /> ORANGEC <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Orange Count THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> g y ACCORDANCE WITH THE POLICY PROVISIONS. <br /> PO Box 8181 <br /> Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE <br /> ©1988-2009 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD <br />