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,.�•-"' y HARRBRO OP ID:RSF <br /> .4Gt�►Rl�►" DATE quwnaYYrn <br /> CERTIFICATE OF LIABILITY INSURANCE 11108/12 <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 pollcy(les)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 endorsemen s. <br /> PRODUCER caNT�cr <br /> Phone- <br /> INSURANCE SERVICE CENTER Fax:910-323-379& PHONE <br /> PO BOX X40736 <br /> FAYETTEVILLE,NC 28309 <br /> INSURANCE SERVICE CENTER <br /> INSURER I3 AAPFOROIN0 COVERAGE NAiC• <br /> INSURERA:STATE AUTO INSURANCE <br /> INSURED HARRIS BR.OS ELEG&CONTROLS,INC � INSURER a:FIRST BENEFITS INSURANCE 13098 <br /> 2712 HILLSBOROUGH RD _ . . __.._. _. ._.. _ __.._ ... <br /> DURHAM,NC 27705 (Nsuru¢ac: <br /> INSURER : <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 /> TYPE CAP INSURANCE <br /> ADWSUIP <br /> IMIMM POLICY NUA1 _. v LIMITS <br /> QENSRAL LIABILITY <br /> [I EACH OCCURRENCE $ 11000r <br /> A X COMMFRCAAL GENERAL LABILITY SOP2691637 07114112 ( 07114/13 _ 00 <br /> CLAIMS-MADE L X J OCCUR 1 mEMISE�tEa�I S 300, <br /> t MAED EXP om 11 10, <br /> v ( PERSONAL d ADV INJURY S 1,000 <br /> GENERAL AGGREGATE _ 5 2,000, <br /> GEWL AGGREGATE LIMIT APPLIES PER <br /> PRODUCTS-COMPIOP AGG S ..._._.....___2,004, <br /> POLICY I X1 LOC <br /> AUTOMOSU LIABILITY C NED SINGLE LIMIT x,000, <br /> A X ANY Aura SAP2357276 � 07114/12 � 07114/18 BODILY INJURY(pat Pawn) S -- T <br /> ALL OWNED F_ SCHEDULED <br /> BODILY INJURY{Pat acadowt) S <br /> X MIRE AUTOS X N S$YVNED ( PROPERTY DAMAGE It <br /> ,�( UMBRELLA LIAa ( OCCUR EACH OCCURRENCE 3 2,000,00 <br /> A Excess LIAa CLAInas naAnEii CXS2110602 j 07114/12 07114113 AGGREGATE s _..... _.. <br /> WORKERS COMPENSATION <br /> AINO EMPLOYOW UASIUTY Yin , X IiTRY�L�T$L R EFL <br /> ANY PROPRIETORlPARTNERIExECUTtVE 5868 07114112 07114113 E,L EACH ACCIDENT S 1,000,00 <br /> OFF CE"EMSER EXCLUDED? NIA <br /> In II{ <br /> EL DISEASE EA EMPLOYE S _ 1'0w00( <br /> 'D'rSd P OF PERATKINS E.L DISEASE-POLICY LIMIT S 1100010 <br /> ba <br /> I i <br /> t <br /> DESCRIPTION OF OPERATIONS t LOCATIONS I VEHICLES(Attach ACORD 101,Addtdanal Ranuuka Schaduia,If more o"as Is requh,*4) <br /> CERTIFICATE HOLDER CANCELLATION <br /> EMERMAN <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> EMERGENCY MANAGEMENT COORDINAT ACCORDANCE WITH THE POLICY PROVISIONS. <br /> ORANGE COUNTY EMERGENCY <br /> SERVICES M AUTHORREDREPREBENTATE <br /> 510 MEADOWLANDS DR Ate;, <br /> MILLSBOROUGH,NC 2 278 <br /> X31588-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010106) The ACORD name and logo are registered marks of ACORD <br />