2012-081 AMS - ALT Services Group for Electric Vehicle Charging Station $84,530

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~~R° CERTIFICATE OF LIABILITY INSURANCE OPID pD DATE~MM/DDlYYYY) 03/29/12 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 REPRESENTATNE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMP RT T: I the certi icate older is an D TIO AL RED, the policy(ies) must be en orsed. S R GA I N IS A D, 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 certi£cate holder in lieu of such endorsement(s). Moore & Johnson Agency PO Box 17867 Raleigh NC 27619 Phone:919-781-0200 Fax:919-582-1999 INSURED Advanced Lighting Technologies LLC DBA ALT Services group P.O. Box 1758 Oxford NC 27565-1758 COVERAGES CERTIFICATE NUMBER: CERTIFICATE HOLDER CANCELLATION CUSTOMER ID #: ADVAN-I. INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: EXC21S10= Insurance CO. INSURER B: Peerleas Indemnity ins. Co. iNSUReac: Peerless Insurance Co an 24198 INSURER D : INSURER E : INSURER F : oe~mm~s~ ~inAenro. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTVJITHSTANDING ANY RE~UIREMENT, 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. L~MITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSR NND POLICY NUMBER (MM/DD/YYYY) {MM/DD/YYYY) LIMITS GENERAL LIABILITY EACHOCCURRENCE $ ZOOOOOO B X COMMERCIALGENERALLIABILITY CBP8497918 oe/zi/i1 oe/21/i2 pREMISES(Eaoccunence) $ ZOOOOO CLAIMS-MADE ^X OCCUR MED EXP (My one person) $ 1 rj ~ 0 ~ X PERSONALBADVINJURY $ ZOOOOOO GENERALAGGREGATE $ ZOOOOOO GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS-COMPlOPAGG $2000000 POLICY ~E ~ $ LOC $ AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT B X ANYAUTO BA8496218 oe/21 l (Eaaccident) $ lOOOOOO /i oe/21/12 BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS }[ PROPERTY DAMAGE $ HIRED AUTOS (Per accideM) NON-OWNED AUTOS g $ C UMBRELLALIAB g OCCUR CU8499418 oe/2i/ii oe/2i/12 EACHOCCURRENCE $ 4QQQQQQ EXCESSLIAB CLAIMS-MADE X AGGREGATE $ QOOOOOO DEDUCTIBLE $ X RETENTION $ O $ j~ WORKERS COMPENSATION ' WC8 7 o7/ie/11 07/19/12 ' . AND EMPLOYERS LIABILITY Y~ N TORY LIMITS ER ANYPROPRIETOR/PARTNER/EXECUTN OFFICER/MEMBER EXCLUDED? ~ ~ A E.L.EACHACCIDENT ~ $ SOOOOOO (MandatoryinNH) If yes describe under E.LDISEASE-EAEMPLOYEE $ ~.OOOOOO , DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ Z O OOOOO B Contractors Equip CBP8497918 oaiz~i~~ oeiz~i~2 Leased or 100,000 Rented DESCRIPTION OF OPERATIONS / LOCATIONS ! VEHICLES (Attaeh ACORD 101, Addifional Remarks Schedule, if more spaee is required) Certificte Holder is named as an Additional Insured with respect to General Liability and Auto. Cancellation no~ice applies per form 17-490 attached. jethompson@co.orange.nc.us SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELNERED IN ACCORDANCE WITH THE POLICY PROVISIONS. County o£ Orange Financial Services P.O. Box 8181 iEiillsborouah NC 27278 AUTHORIZED ~. ~`~- ~~- O 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD