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DocuSign Envelope ID: 1DFCB082-2DBE-4FF6-A29E-A75A452063D6
<br /> OP ID: DL
<br /> - '� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/OD1 YYY,.
<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 fS 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 /> Tyson Insurance Services,Inc.
<br /> NAME:
<br /> 2609 N Duke St Suite 102 PHONE
<br /> P.0.Box 15734 ANC,No,Extt: FAX Nol:
<br /> Durham,NC 27704- ADDRESS: -
<br /> Diane S.Lon PRODUCER
<br /> Long CUSTOMERID# DU: RHEI-E
<br /> -
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURED Durham Electric Co., Inc. INSURER A:Penn Nat. Mut. Cas. Ins.Co. 114990
<br /> 807 N. Mangum Street INSURER B:Builders Mutual Insurance Co.
<br /> Durham, NC 27701
<br /> INSURER C i
<br /> INSURER D: _
<br /> INSURER E:
<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 .ADDL:SUBRI POLICY EFF POLICY EXP
<br /> LTR I TYPE OF INSURANCE INSR'WVD` POLICY NUMBER (MM/DDIYYYY)i(MM/DDIYYYY) LIMITS
<br /> I GENERAL LIABILITY
<br /> I— - EACH OCCURRENCE $ 1,000,000
<br /> A Xl COMMERCIAL GENERAL LIABILITY X X AC90075556 05/03/2016105/03/2017 DAMAGE 7i)RENTED
<br /> PREMISES(Ea occurrence) $ 50,000
<br /> J CLAIMS-MADE i X OCCUR MED EXP(Any one person) $ 5,000
<br /> --.-.
<br /> PERSONAL&AOVINJURY $ 1,000,000
<br /> GENERAL AGGREGATE . $ 2,000,000
<br /> I GEN'L AGGREGATE LIMIT APPLIES PER: � , PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> ( PRO-
<br /> T POLICY, ,lECT X 1 LOC ? I i I $
<br /> AUTOMOBILE LIABILITY I
<br /> COMBINED SINGLE LIMIT
<br /> (Ea accidenO $ 1,000,000
<br /> A X ANY AUTO IAX90075556 05/0312016 05/03/2017!
<br /> BODILY INJURY(Per person) $
<br /> ALL OWNED AUTOS BODILY INJURY(Per accident) $
<br /> SCHEDULED AUTOS PROPERTY DAMAGE
<br /> : •HIRED AUTOS i(PER ACCIDENT) $
<br /> I X I NON-OWNED AUTOS $
<br /> UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 6,000,000
<br /> EXCESS LIAB CLAIMS-MADE
<br /> A — UL90075556 05/03/2016 05/03/2017 I AGGREGATE $ 6,000,000
<br /> DEDUCTIBLE $
<br /> j X l RETENTION $ 0 i$
<br /> WORKERS COMPENSATION X WC STATU- 0TH-
<br /> AND EMPLOYERS'LIABILITY _ TORY LIMITS ER
<br /> B I ANY PROPRIETOR/PARTNER/EXECUTIVE YIN WCP002074417 07/08/2016 07/08/2017 I E.L.EAGH_ACCIDENT ' $ 1,000,000
<br /> OFFICER/MEMBER E XCLUDED? N!A X —
<br /> (Mandatory In NH) I E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000
<br /> A Inst.Floater/ �AC90075556
<br /> ■ 05/03/2015 06/03/2017'Coverage 500,000
<br /> Builders Risk I Dad. 1,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required)
<br /> Orange County,its officers official agents&employees are Additional
<br /> Insureds with respects to General 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 i
<br /> added for General Liab.,Auto L.iab. &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 /> J y ACCORDANCE WITH THE POLICY PROVISIONS,
<br /> P,O, Box 8181
<br /> Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE
<br /> Mane S. Long _^�
<br /> 1 Ck
<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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