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DocuSign Envelope ID: 119AF03D-E3C0-4F02-B437-70D08DB32D3E <br />OP10:C1 <br />DATE(MMIOOIVYYV) <br />CERTIFICATEOFLIABILITYINSURANCE <br />04/29/2015 <br />THISCERTIFICATEISISSUEDASAMAnEROFINFORMATIONONLYANDCONFERSNORIGHTSUPONTHECERTIFICATEHOLDER.THIS <br />CERTIFICATEDOESNOTAFFIRMATIVELYORNEGATIVELYAMEND,EXTENDORALTERTHECOVERAGEAFFORDEDBYTHEPOLICIES <br />BELOW.THISCERTIFICATEOFINSURANCEDOESNOTCONSTITUTEACONTRACTBETWEENTHEISSUINGINSURER(S),AUTHORIZED <br />REPRESENTATIVEORPRODUCER,ANDTHECERTIFICATEHOLDER. <br />endorsed. <br />endorsement <br />endorsement{s). <br />PRODUCER <br />TheInsuranceCenlerofDurham <br />P:~Jo <br />919-471-2541 <br />919-471.2132 <br />Ext!" <br />Durham,NC27704- <br />HAIGLE1 <br />PRODUCER <br />JackSherron,CPCU <br />INSURER'SlAFFORDINGCOVERAGE <br />ScoltHaiglerElectric <br />INSURED <br />18988 <br />JNSURERA: <br />6616BlalockRoad <br />JNSURERB: <br />27503 <br />Bahama,NC <br />JNSURERC: <br />IN$URERD: <br />INSURERE: <br />INSURERF: <br />COVERAGES <br />CERTIFICATENUMBER:REVISIONNUMBER: <br />THISISTOCERTIFYTHATTHEPOLICIESOFINSURANCELISTEDBELOWHAVEBEENISSUEDTOTHEINSUREDNAMEDABOVEFORTHEPOLICYPERIOD <br />INDICATED.NOTVVITHSTANDINGANYREQUIREMENT,TERMORCONDITIONOFANYCONTRACTOROTHERDOCUMENTIJIJITHRESPECTTOVv'HICHTHIS <br />CERTIFICATEMAYBEISSUEDORMAYPERTAIN,THEINSURANCEAFFORDEDBYTHEPOLICIESDESCRIBEDHEREINISSUBJECTTOALLTHETERMS, <br />EXCLUSIONSANDCONDITIONSOFSUCHPOLICIES.LIMITSSHOVv'NMAYHAVEBEENREDUCEDBYPAIDCLAIMS. <br />tieR <br />INSR <br />1,~L1CYv~FPDL~c;.~ <br />TYPEOFINSURANCE <br />LIMITS <br />POLICYNUMBER <br />.MMIOOIYMMIO <br />~NERALL1ABIUTY <br />1,000,00< <br />~~CHOCCURRENCE <br />358529913 <br />091131201409/13/2015 <br />A100,00< <br />OMMERCIo\LGENERALlIABILITY <br />PREMISEEaOCOJrrencel <br />5,00< <br />_CLAIMS-MADEOCClfl <br />MEDEXP(Anyoneperson) <br />1,000,00< <br />PERSONALIOVINJURY <br />& <br />2,OOO,00( <br />GENERAlAGGREGATE <br />2,000,00 <br />PRODUCTS.CO'YIPIOPAGG <br />~'LAG~E~t,LIMITAPr!~rIPER <br />POLICYlOC <br />COMBINEDSINGlELIMIT <br />~TDMDBllELIABiliTY <br />(Eaacadsnt) <br />ANYAUTO <br />BODILYINJURY(pefperson) <br />ALLQ'M,IEOAUTOS <br />BOOILYINJURY(Peraeodent) <br />SCHEDULEDAUTOS <br />PROPERTYDAMAGE <br />(PERACCIDENT) <br />HIREDAUTOS <br />NON.QV'oNEOAUTOS <br />UMBRELlAL1AB <br />EACHOCCURRENCE <br />OCCLFl <br />EXCESSL1AB <br />CLAIMS-MADEAGGREGATE <br />DEDUCTIBLE <br />RETENTION <br />WORKERSCOMPENSAnON <br />ANOEMPLOYERS'LIABILITY <br />[Y] <br />Y'N <br />100,00 <br />02104120150210412016 <br />B <br />16JUB5033P61915 <br />ANYPROPRIETORJPARTNERiEXECUTI\lEELEACHACCIDENT <br />N'. <br />OFFICERIMEMBEREXCLUDED? <br />100,00 <br />(MandatoryInNH) <br />E,L.DISEASE.EAEMPLOYE <br />~~~~rpS:W~ <br />500,00 <br />O~~ERATtONSbelow <br />ELDISEASE-POLeyLIMIT <br />~[if~IT~1cYAWERATlONSIlOCATIONSVEHICLES(AttachACOROtal,AdditionalRemar1<.sSchedule,motespaceisrequired) <br />CANCELLATION <br />CERTIFICATEHOLDER <br />ORAN016 <br />SHOULDANYOFTHEABOVEDESCRIBEDPOLICIESBECANCELLEDBEFORE <br />IN <br />THEEXPIRATIONDATETHEREOF,NOTICEBEDELIVERED <br />WILL <br />ACCORDANCEWITHTHEPOLICYPROVISIONS. <br />POBox8181 <br />Hillsborough,NC27278 <br />AUTHORIZEDREPRESENTATIVE <br />@1988-2009ACORDCORPORATION.Allri9htsreserved. <br />ACORD25(2009109)TheACORDnameandlogoareregisteredmarksofACORD <br />