2024-522-E-Emergency svc-D&C Instruction-HMEP Grant Funded Class

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ACORD® CERTIFICATE OF LIABILITY INSURANCE I DA TE (MM/DDIYYYY) � 07/31/20 24 THIS CERllFICATE IS ISSUED AS A MATTER OF INFORMAllON ONLY AND CONFERS NO RIGHTS UPON THE CERllFICATE HOLDER. THIS CERllFICATE DOES NOT AFFIRMAllVELY OR NEGAllVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTAllVE OR PRODUCER, AND THE CERllFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGAllON IS WAIVED, subject to the terms and conditions of the po licy, ce rtain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such end orseme nt(s). PRODUCER CO NTACT Nancy KontioNAME: Bowen Insurance Agency, Inc. -Raleigh lp_�gN�o Extl: (919)841-1099 I FAX IA/C N ol : (919)848-7977 8220-201 Creedmoor Road E-MAIL nancy@bO'Nen insu ranee. comADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# Raleigh NC 27613 I NSURER A: Erie lsurance I NSURED I NSURERS: Donald Gross I NSURER C: 465 Big Willow Way I NSURER □: I NSURER E: Rolesville NC 27571 I NSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLU SIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR A TYPE OF INSURANCE X COMMERCIAL GENERAL LIABILITY -D CLAIMS-MADE [RI OCCUR - -GEN'L AGGREGATE LIMIT APPLIES PER: � □ PRO-POLICY JECT OTHER: AUTOMOBILE LIABILITY -ANY AUTO -- DLoc OWNED SCHEDULED AUTOS ONLY AUTOS -HIRED � NON-0'11,NED -AUTOS ONLY AUTOS ONLY UMBRELLA LIAB H OCCUR EXCESS LIAB CLAIMS-MADE OED I I RETENTION$ WO RKERS COMPENSATIO N AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTI VE □ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below ADDL SUBR POLICY EFF POLICY EX P POLICY NUMBER IMMIDDIYYYYI IMM/DDIYYYYI y Q36-2700443 12/27/2023 12/27/2024 N/A LIMITS EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence l $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OP AGG $ 2,000,000 $ COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE fPer ac cidenn $ EACH OCCURRENCE $ AGGREGATE $ $ I PER I STATUTE I OTH-ER E.L EACH ACCIDENT $ E.L DISEASE -EA EMPLOYEE $ E.L DISEASE - POLICY LIMIT $ DESCRI PTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Orange County is listed as Additional Insured on GL policy. CERTIFICATE HOLDER CA NCELLA TION SHOULD ANY OF lHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRAllON DATE THEREOF, NOTICE WILL BE DELIVERED IN Orange County ACCORDANCE WITH THE POLICY PROVISIONS. PO BOX8181 (300 West Tryon St.) Hillsborough, NC 27278 AUTHORJ1ED REPRESEN�VE �4;1s I Fax: Email: @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Docusign Envelope ID: F190FBF3-F6C4-4E89-84DD-4C180C722B66