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DocuSign Envelope ID: 21BF91F6-B248-4D42-BB0F-0B51048AC927 DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE THISCERTIFICATEISISSUEDASAMATTEROFINFORMATIONONLYANDCONFERSNORIGHTSUPONTHECERTIFICATEHOLDER.THIS CERTIFICATEDOESNOTAFFIRMATIVELYORNEGATIVELYAMEND,EXTENDORALTERTHECOVERAGEAFFORDEDBYTHEPOLICIES BELOW.THISCERTIFICATEOFINSURANCEDOESNOTCONSTITUTEACONTRACTBETWEENTHEISSUINGINSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT:IfthecertificateholderisanADDITIONALINSURED,thepolicy(ies)mustbeendorsed.IfSUBROGATIONISWAIVED,subjectto thetermsandconditionsofthepolicy,certainpoliciesmayrequireanendorsement.Astatementonthiscertificatedoesnotconferrightstothe certificate holder in lieu of such endorsement(s). CONTACTPRODUCERNAME: FAXPHONE(A/C, No):(A/C, No, Ext): E-MAILADDRESS: INSURER(S) AFFORDING COVERAGENAIC # INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : COVERAGESCERTIFICATE NUMBER:REVISION NUMBER: THISISTOCERTIFYTHATTHEPOLICIESOFINSURANCELISTEDBELOWHAVEBEENISSUEDTOTHEINSUREDNAMEDABOVEFORTHEPOLICYPERIOD INDICATED.NOTWITHSTANDINGANYREQUIREMENT,TERMORCONDITIONOFANYCONTRACTOROTHERDOCUMENTWITHRESPECTTOWHICHTHIS CERTIFICATEMAYBEISSUEDORMAYPERTAIN,THEINSURANCEAFFORDEDBYTHEPOLICIESDESCRIBEDHEREINISSUBJECTTOALLTHETERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDLSUBRINSR POLICY EFFPOLICY EXPTYPE OF INSURANCE LIMITSPOLICY NUMBERLTR (MM/DD/YYYY)(MM/DD/YYYY)INSDWVD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE$ DAMAGE TO RENTEDCLAIMS-MADEOCCUR $PREMISES (Ea occurrence) MED EXP (Any one person)$ PERSONAL & ADV INJURY$ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ PRO-POLICYLOC PRODUCTS - COMP/OP AGG$JECT $OTHER: COMBINED SINGLE LIMITAUTOMOBILE LIABILITY $(Ea accident) BODILY INJURY (Per person)$ANY AUTO ALL OWNEDSCHEDULED BODILY INJURY (Per accident)$AUTOSAUTOSNON-OWNED PROPERTY DAMAGE $HIRED AUTOS (Per accident)AUTOS $ UMBRELLA LIAB EACH OCCURRENCE$OCCUR EXCESS LIAB CLAIMS-MADE AGGREGATE$ $DEDRETENTION$ PEROTH-WORKERS COMPENSATION STATUTEERAND EMPLOYERS' LIABILITY Y / NANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT$N / AOFFICER/MEMBER EXCLUDED? (Mandatory in NH)E.L. DISEASE - EA EMPLOYEE$ If yes, describe under E.L. DISEASE - POLICY LIMIT$DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDERCANCELLATION SHOULDANYOFTHEABOVEDESCRIBEDPOLICIESBECANCELLEDBEFORE THEEXPIRATIONDATETHEREOF,NOTICEWILLBEDELIVEREDIN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORDACORD 25 (2014/01) BISHOP1OP ID: SF 08/22/2014 Tara J. SmithwickFirst Insurance Services, Inc. P. O. Box 13687RTP, NC 27709Sandy B. Fisher 919-941-0549919-941-0135 Selective Insurance Company12572 Builders Mutual Insurance Co10844WL Bishop Construction Co 2211 Leah Road Hillsborough, NC 27278 AX 1,000,000 X X S 199192109/04/201409/04/2015 500,000 10,000 1,000,000 3,000,000 X 3,000,000 1,000,000 AX X S 199192109/04/201409/04/2015 XX XX 5,000,000 A S 199192109/04/201409/04/2015 5,000,000 0X X B WCP1020372 EXCLUDE09/04/201409/04/2015 1,000,000YMIKE & WILLIAM BISHOP 1,000,000 1,000,000 A Contractors EquipS 199192109/04/201409/04/2015 Limit75,000 Leased/Rented Deductibl1,000 County of Orange Financial Services is additional insured for General Liability and Auto Liability if required by written/executed contract, before a loss. Cancellation notice applies per the attached IL0269 0908. ORANGE4 County of Orange Financial Services PO Box 8181 Hillsborough, NC 27278 DocuSign Envelope ID: 21BF91F6-B248-4D42-BB0F-0B51048AC927