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>6,*1$785(3$*(72)2//2:@ DocuSign Envelope ID: 6A8D2620-5090-4F5D-A1D7-A3B93CBDBA8F 5HYLVHG ,1:,71(66:+(5(2)WKH3DUWLHVKHUHWRKDYHH[HFXWHGWKLV$JUHHPHQWDVRIWKHGD\DQG GDWHILUVWDERYHZULWWHQZKROO\RULQDQXPEHURIFRXQWHUSDUWVHDFKRIZKLFKVKDOOZLWKRXWSURRIRU DFFRXQWLQJIRURWKHUFRXQWHUSDUWVEHGHHPHGDQRULJLQDOFRQWUDFW 25$1*(&2817<&2175$&725 BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB 6LJQDWXUH 6LJQDWXUH &RXQW\0DQDJHU BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB 3ULQWHG1DPHDQG7LWOH DocuSign Envelope ID: 6A8D2620-5090-4F5D-A1D7-A3B93CBDBA8F DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY 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 REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACTPRODUCERNAME: FAXPHONE(A/C, No):(A/C, No, Ext): E-MAILADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDL SUBRINSR POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITSPOLICY NUMBERLTR (MM/DD/YYYY) (MM/DD/YYYY)INSD WVD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGG $JECT $OTHER: COMBINED SINGLE LIMITAUTOMOBILE LIABILITY $(Ea accident) BODILY INJURY (Per person) $ANY AUTO ALL OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS AUTOSNON-OWNED PROPERTY DAMAGE $HIRED AUTOS (Per accident)AUTOS $ UMBRELLA LIAB EACH OCCURRENCE $OCCUR EXCESS LIAB CLAIMS-MADE AGGREGATE $ $DED RETENTION $ PER OTH-WORKERS COMPENSATION STATUTE ERAND 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 HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 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) BISHOP1 OP ID: SF 08/22/2014 Tara J. SmithwickFirst Insurance Services, Inc. P. O. Box 13687RTP, NC 27709Sandy B. Fisher 919-941-0549 919-941-0135 Selective Insurance Company 12572 Builders Mutual Insurance Co 10844 WL Bishop Construction Co 2211 Leah Road Hillsborough, NC 27278 AX 1,000,000 X X S 1991921 09/04/2014 09/04/2015 500,000 10,000 1,000,000 3,000,000 X 3,000,000 1,000,000 AX X S 1991921 09/04/2014 09/04/2015 XX XX 5,000,000 A S 1991921 09/04/2014 09/04/2015 5,000,000 0X X B WCP1020372 EXCLUDE 09/04/2014 09/04/2015 1,000,000YMIKE & WILLIAM BISHOP 1,000,000 1,000,000 A Contractors Equip S 1991921 09/04/2014 09/04/2015 Limit 75,000 Leased/Rented Deductibl 1,000 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: 6A8D2620-5090-4F5D-A1D7-A3B93CBDBA8F