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DocuSign Envelope I D:40AOE7DE-3ClE-4A74-9237-4A9ElFB8FAB4 <br /> DATE(MMIDDIYYYY) <br /> Ac"R" CERTIFICATE OF LIABILITY INSURANCE 10/02/2'015 <br /> ---- ­­--­­­ ........ ............ <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 /> ----------- .......... <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(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 endorsement(s). <br /> ............ <br /> PRODUCER CONTACT <br /> _NA_M9__............. <br /> HPB INSURANCE GROUP INC PHONE <br /> 661-3938 Aac � 888_!!_r?-19211 <br /> P 0 BOX 890 EMAIL <br /> HIGH POINT,NC 27261 ADDBE§§:Service.conter trave$ers.com <br /> (888)661-3938 INSURER(S)AFFORDING COVERAGE NAIL# <br /> INSURER A^THE PHOENIX INSURANCE COMPANY <br /> ....................... ........ .......... <br /> i [Wi6 ..RED <br /> INSURER B <br /> TARHEEL GENERATOR LLC ­ <br /> INSURER. 11 C 11 __--------- <br /> PO BOX 753 . ........ --— <br /> SILER CITY, NC 27344 INSURER D: <br /> ............................... ............. .......... .......... <br /> INSURER E" <br /> INSURER F:: <br /> ——----------I.......... <br /> COVERAGES CERTIFICATE NUMBER: 68 37 97 2501 90572 REVISION NUMBER: <br /> THIS IS 701 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 CONDIT4ON 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 rERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, <br /> iNSR ADD L SUBA POLICY EFF POLICY <br /> LTR TYPE OF INSURANCE INS[) WVD POLICY NUMBER 1P 1, .1.1111�1 � LIMITS <br /> ...... _IMM pif IM ------------------------__--- <br /> A X­ COMMERCIAL GENERAL LIABILITY x 680-6A560612-1 5 09/1712015 0911712016 EACH OCCURRENCE $1�000,000 <br /> CLAIMS-MADE L OCCUR $350,000 <br /> X MRFDAUTO MED EXP An one person� $5,000 <br /> NON OWNED AUTO PERSONAL&ADV INJURY $1,000,000 <br /> ­­....... ............. <br /> GEN;L AGGREGATE UMITAPPLIES PER', Gl"NERAL AGGREGATE _L2_,000,000 <br /> POLICY 0 FRO_ OLOC <br /> JECT PRODUCTS-COM�PIOP AG�G $2,000,000 <br /> OTHER„ $ <br /> COMBINED SINGLE LIMIT <br /> AUTOMOBILE LIABILITY (Ea arcdenl) $ <br /> ANY AUTO BODILY INJURY(Per person), $ <br /> ALL OWNED SCHEDULED <br /> 'A.TOS AUTOS BOOK Y INJURY(Per accident I $ <br /> HIRE DAUTOS NON-OWNED <br /> AUTOS PROPERTY DAMAGE <br /> IPer acddent) $ <br /> $ <br /> UMBRELLA U; EACH OCCUIRRENCE $ <br /> EXCESS LIAR CLAIMS-MADE AGGREGArE $ <br /> DF 01 1 RETLN PON$ <br /> WORKERS COMPENSATION NIA <br /> AND EMPLOYERS'LIABILITY Y/N <br /> ANY PROPRIETORMARTNEWEXECUTIVE E.L.EACH ACCIDENT $ <br /> 0FRCERMEMBER EXCLUDED? <br /> (Mandatory in NH) E.L.DISEASE-EA EM:PLOYEE $ <br /> If rs.describe undef <br /> T)-SCRWTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS r LOCATIONS d VELITCLES(ACORD 101,Additional Remarks Schedule,may be attached V more space is required) <br /> AS RESPECTS TO GENERAL LIABILITY,ORANGE COUNTY IS ADDITIONAL INSURED-BLANKET ADDITIONAL,INSURED <br /> -OWNERS,LESSEES OR CONTRACTORS,CG D1 05,BUT ONLY AS RESPECTS TO WORK PERFORMED BY THE INSURED. <br /> CERTIFICATE HOLDER CANCELLATION <br /> ORANGE COUNTY 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,NO 27278 ACCORDANCE WITH THE POLICY PROVISIONS, <br /> AUTHORIZED REPRESENTATIVE <br /> ­­-----------i_­­______._w....... .......... <br /> 1988-2014 ACORID CORPORATION.All rights reserved. <br /> ACORD 25(2014/0'1) The ACORID name and logo are registered marks of ACORD <br />