2016-538-E AMS - Harris Brothers Electric & Controls, Inc. to install control unit and power

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DocuSign Envelope ID: 152624D9-C913-4DA9-84D5-72704A709310 AC a� DATE(MM/DD/YYYY) 1...A\...//�L/ CERTIFICATE OF LIABILITY INSURANCE 9/8/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Debby Blanchard NAME: y Glick & Mahan Agency (A/C,NN,Ext): (336)228-0525 FAX No): (336)229-0900 ............ 2326 South Church St. E-MAIL ADDRESS:blanchd3 @nationwide.com Ste C INSURER(S)AFFORDING COVERAGE NAIC# Burlington NC 27215 INSURERA:DONEGAL INSURANCE GROUP 13692 INSURED ......... ......... ......... ......... ......... ......... ......... ......... ......... INSURER B: HARRIS BROTHERS ELECTRIC AND CONTROLS INC INSURER C: 2712 HILLSBOROUGH ROAD INSURER D: INSURER E: DURHAM NC 27705 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1672500409 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 100,000,,,, CPP8925539 07/14/2016 07/14/2017 MED EXP(Any one person) $ 5,000 A PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED CA8925539 07/14/2016 07/14/2017 BODILY INJURY(Per accident) $ A , AUTOS NON OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS (Per accident) $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE CX8925539 07/14/2016 07/14/2017 AGGREGATE $ 5,000,000 DED RETENTION$ $ WORKERS COMPENSATION Y/N X l STPER ATUTE 1 I. OTH- - AND EMPLOYERS'LIABILITY .....ER ...... ANY PROPRIETOR/PARTNER/EXECUTIVE WC8925539 07142016 07142017 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A .. ........ A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under ....... ......... ......... ......... ......... ................... DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION abarnes @orangecountync.gov SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ORANGE COUNTY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO BOX 8181 ACCORDANCE WITH THE POLICY PROVISIONS. HILLSBOROUGH, NC 27278 - AUTHORIZED REPRESENTATIVE ©19` 2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)