2017-116-E DEAPR - Carolina Gate Control for automated gate controllers

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I DocuSign Envelope ID: CB1D9758-FE9A-4EEB-834D-199A3281BCOB 5 DocuSign Envelope ID:6B0490A6-FD36-47D8-8ECC-8D4299EF2D71 .' 7 ® DATE(MMIDDIYYYY) AC RO CERTIFICATE OF LIABILITY INSURANCE 01/27/2017 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(les)must have ADDITIONAL INSURED provisions or 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). I PRODUCER CONTACT Jennifer Goodman NAME: t Piedmont Insurance Associates PHONE No.Extk (704)987-3901 FAX No):(888)236-0940 1 E-MAIL PO Box 406, ADDRESS: jgoodman@pledmont-ins.com Huntersville,NC 28070 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Erie Insurance Exchange 26271 INSURED INSURER B: Li CAROLINA GATE CONTROL LLC Andrew Pease INSURER C: 4 916 W Trinity Ave#16 INSURER D: E Durham, NC 27701-1771 INSURERS: INSURER F: COVERAGES CERTIFICATE NUMBER: 00000000-71738 REVISION NUMBER: 2 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, I EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WYD (MMIDD/YYYY) (MMIDWYYYYI I A X COMMERCIAL GENERAL LIABILITY Q34-2720990 10/27/2016 10/27/2017 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PREMISES O(EaonwErrence) $ 1,000,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 , GEN'L AGGREGATE LIMIT APPLIES PER: ( GENERAL AGGREGATE $ 2,000,000 1 j78,-X POLICY n I __I LOC I PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: I $ A AUTOMOBILE LIABILITY Q34-2720990 10/27/2016 10/27/2017 (EOaaBddeD�SINGLELIMIT $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per acddent) 5 AUTOS ONLY AUTOS — WN HIRED NON-OED PROPERTY DAMAGE $ X AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB _OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE S DED I RETENTION$ 5 A AND EMPLOYERS'LIABILITY Y,(N Q94-2700565 10/27/2016 10/27/2017 STATUTE I EERH ANY PROPRIETOR/PARTNER/EXECUTIVE I I E.L.EACH ACCIDENT 5 100,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 100,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) 0 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Orange County Government ACCORDANCE WITH THE POLICY PROVISIONS. 200 S.Cameron St Hillsborough, NC 27278 AUTHORIZED REP•ESENTA TIVE ; (JLG) ©1988-201 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD . Printed by JLG on January 27,2017 at 11:22AM