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DocuSign Envelope ID:0357B852-8C7E-4F80-BC7A-1ECD7B8CA959 <br /> 0 DATE JMMAIDNYYY) <br /> AC"R" <br /> CERTIFICATE OF LIABILITY INSURANCE 01/05/2015 <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 BELOW. THIS <br /> CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR <br /> PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the poficy(ies) must be endorsed. If SUBROGATf,ON IS WAIVED, subject to the terms <br /> and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate:holder <br /> In lieu of such endorsement'sl. <br /> PRODUCER CONTACT <br /> ... -R ....... <br /> FEDERATED MUTUAL INSURANCE COMPANY NT.CQ-N—TACT CE NTIE PHONE <br /> HOME OFFICE: P.O. BOX 328 <br /> 1A <br /> .......... <br /> OWATONNA, MN 55060 E-MAIIL <br /> ADDRESS:CLIIENTCONTACTCENTERCo EEgI'.NS CO.M.... ............ .......... <br /> MSURERIS)AFFORDING COVERAGE NAIL Mt <br /> INSURER A: FEDERATED MUTUAL INSURANCE COMPANY' 139�35 <br /> -----....... ...... <br /> INSURED 346-500-2 INS URER 8 <br /> WARREN HAY MECHANICAL CONTRACTORS INC rMSURER C: <br /> PO BOX�818 .............. <br /> INSURER M <br /> HILLSBOROUGH, NC 27278 <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:60 REVISION NUMBER:2 <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 CONWTION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLiCIIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS <br /> AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> lNSR TYPE OF INSURANCE AD�DL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS <br /> L.T. IN$R WVD (MMMWYYYYI (MMrDDJYYYY)i <br /> GENERAL LIABILITY EACH OCCURRENCE $1,000,000 <br /> DAMAGE ro RENTED ..... ---—------ 'i1"00-J000 <br /> X COMMERCIAL GENERAL LIABILITY — S�F,�lEa 9EqmE[qnc:o <br /> 1 <br /> -ER�MJ - -— — <br /> CLAJMS-MADE x OCCUR MED EXP(Any one person) EXCLUDED <br /> A N N 9893360 12/31/2014 12131/2015 PERSONAL K ADV MJURY $1,000,000 <br /> GENERAL AGGREGATE $2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMPIOP AGO $2 000,000 <br /> R <br /> I X]POLICY -------I <br /> PR L Loc <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 <br /> X ANY AUTO BODILY INJURY[Per Person) <br /> ALL OWNED SCHEDULED ----- <br /> A AUTOS AUTOS N N 9893360 12/31/2014 1213112015 BODR,Y INJURY(per acd:dono <br /> NON-OWNEID DAM GE <br /> HIRED AUTOS AUTOS -IFer--accICLIMI) <br /> UMBRELLA LIAS �XOCCUR EACH OCCURRENCE $3,000,000 <br /> -—------- ...... <br /> A EXCESS LIAR ctAims-mADE. N IN 9893361 12131/2014 1213112015 AGGREGATE $3,00,0,000 <br /> - ........... <br /> I IDE RE T EN T I ON <br /> WORKERSCOMPENSATION <br /> ___?� WC,,S T'M r ER <br /> TH- <br /> T i <br /> AND EMPLOYERS'LIAOILITY YIN _1_ _L__ <br /> ANY PROPRIETORJPARTNERIEXECUTIVE [­- E.L EACH ACCIDENT $500,00,0 <br /> A OFnCERiMEMBER EXCLUDED N/A N 9076999 12131/2,014 12/31/2015 <br /> Iman,datory in NH) E.L.DISEASE,EA EMPLOYEE $500,000 <br /> Il'yes,describe under E L DISEASE-POLICY'LIMIT <br /> DESCRIPTION OF OPEkA11ONS berow $500,000 <br /> C'up E I V E.FN <br /> DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES IAftach ACORD 101,Addificnal Remarks Schedule,it more space is required) <br /> IAN 13 <br /> CERTIFICATE HOLDER CANCELLATION <br /> 346-500-2 60 2 <br /> ORANGE COUNTY PUBLIC WORKS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> PO BOX 8181 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> HILLSBOROUGH, NC 27278-8181 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> Q 1988-2010 ACORD CORPORATION, All rights reserved. <br /> ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD <br />