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DocuSign Envelope ID:7B2CBCO2-5439-4FB9-8D4B-ECOA1D0A2292
<br /> n F� /r' OP ID: DL
<br /> 4� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
<br /> 09/07/2016
<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 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 /> PRODUCER CONTACT
<br /> NAME:
<br /> Tyson Insurance Services,Inc, PHONE !FAX
<br /> 2609 N Duke St Suite•102 TA/C,No,Ex01.. (ANC,No):
<br /> P.0.Box 15734 E-MAIL
<br /> Durham,NC 27704- ADDRESS:PRODUCER
<br /> Diane S.Long ,CUSSTOMER ID a:DURHELE
<br /> INSURER(S)AFFORDING COVERAGE NAIC t/
<br /> INSURED Durham Electric Co., Inc, INSURER A_Penn. Nat. Mut. Cas. Ins.Co. 14990
<br /> 807 N. Mangum Street INSURER e:Builders Mutual Insurance Co,
<br /> Durham, NC 27701
<br /> INSURER C:
<br /> INSURER O:
<br /> INSURER E, �W
<br /> INSURER F:
<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 /> INSR I TYPE OF INSURANCE 'INSR• U L1 (MM/DDIYYYY)'(MM/DO!YYYY)I LIMITS
<br /> LTR I DD • UBRI POLICY NUMBER
<br /> GENERAL LIABILITY
<br /> FT EACH OCCURRENCE 5
<br /> 1,000,000
<br /> A XI COMMERCIAL GENERAL LIABILITY X X AC90075556 05/03/2016 i 05/03/2017 D AGE TO RENTED
<br /> PREMISES(Ea occurrence) s 50,000
<br /> J CLAIMS-MADE i X OCCUR MED EXP
<br /> (Any one parson) $ 5,000
<br /> An
<br /> •
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> , ,..— _ GENERAL AGGREGATE $ 2,000,000
<br /> GENT AGGREGATE LIMIT APPLIES PER: I ;PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> PRO ---
<br /> I POLICY c I I JECT- X I LOC 1 I j I ---•-- - _
<br /> �I AUTOMOBILE LIABILITY I I COMBINED SINGLE LIMIT $ 1,000,000
<br /> A : X ANY AUTO
<br /> �AX90075556 05/03/2016 05/03/2017 I(Ea accident)
<br /> BODILY INJURY(Per person) $
<br /> ALL OWNED AUTOS i BODILY INJURY(Per accident).$
<br /> .SCHEDULED AUTOS PROPERTY DAMAGE
<br /> X• HIRED AUTOS (PER ACCIDENT) g
<br /> 4 X I NON-OWNED AUTOS $
<br /> $UMBRELLA LIAB X OCCUR r EACH OCCURRENCE ' $ 6,000,000
<br /> exCeSs LIAR
<br /> CLAIMS-MADE AGGREGATE $ 6,000,000
<br /> -- UL90075556 ' 05/03/2016 05/03/2017 ------
<br /> . DEDUCTIBLE $
<br /> I X
<br /> • RETENTION $ 0 ! IS
<br /> WORKERS COMPENSATION X WC STATU- OTH-
<br /> I AND EMPLOYERS'LIABILITY YIN tY-- TORY LIMITS ER I
<br /> tH. IANY PROPRIETOR/PARTNER/EXECUTIVE WCP002074417 07/00/2016 07100/2017 I E.L.EACH ACCIDENT i$ 1,000,000
<br /> •OFFICER/MEMBER EXCLUDED? N/A x � ,....-._.�—_.�
<br /> r(Mandatory In NH) 1 E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> (ryes,describe under
<br /> DESCRIPTION OF OPERATIONS below • I E.L.DISEASE-POLICY LIMIT S 1,000,000
<br /> A Inst.Floater/ IAC90075556 1 05/03/2015 05/03/2017 1Coverage 500,000
<br /> Builders Risk I I Bed. 1,000
<br /> •DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES (Attach ACORD 101,Additional Remarks Schedule,Ir more space Is required)
<br /> Orange County, its officers official agents &employees are Additional
<br /> Insureds with respects to Genera! Liability, per attached forms.Waiver of
<br /> subrogation has been added to Work Comp,endorsement to follow directly from
<br /> the Company. Umbrella follows form. 30 day notices of cancellation have been
<br /> added for General Lie .,Auto Liab. &Work Comp,endorsements to follow, ,
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> ORANC07
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> y ACCORDANCE WITH THE POLICY PROVISIONS,
<br /> P,O, Box 8181
<br /> Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE
<br /> Diane S. Long
<br /> 1 - (4. Q
<br /> ©1988-2009 ACORD CORPORATION, All rights reserved.
<br /> ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD
<br />
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