2018-593-E AMS - Harris Bros Veterans Office fan install

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DocuSign Envelope ID:39ED8DE6-20A4-4CD2-8A1 E-7EA80B9DF6F8 DocuSign Envelope ID:98837986-D2B9-41A2-9776-F767CDAC7A6C "4+°R°� CERTIFICATE OF LIABILITY INSURANCE DA�E7114=17 YI 07/14/2017 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: It the certificate holder Is an ADDITIONAL INSURED, the policy(ies) 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 Ileu of such endorsement s PRODUCER conrAOT -CLIENT CONTACT CENTER FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE:P.O.BOX 328 PAICNrFIe . :888-3334949 €tic Ho:507.446-4664 01/VATONNA,MN 55060 ADDRESS:CLIENTCONTACTCENTER D S.CO INSURER(S)AFFORDING COVERAGE NAIC# INSURER A;FEDERATED MUTUAL INSURANCE COMPANY 139x5 INSURED 252-856-0 INSURER B: HARRIS BROTHERS ELECTRIC AND CONTROLS,INC. INSURER C, 2712 HILLSBOROUGH RD DURHAM,NC 27705-4044 INSURER 0: INSURER F; INSURER F- COVERAGES CERTIFICATE NUMBER:36 REVISION NUMBER:I THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE 1146ti. 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 19 SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE Dr,90OR POLICY NUMBER POLICY EFF POLICY EXP LTR s rDDIY MtDDJYyYY1 LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE O OCCUR E CCU're ce $100,DD0 MED EXP IAny one person) EXCLUDED A N N 6048918 07114/2017 07114/2018 PERSONAL a ADV INJURY $1,000,000 MOTHER: 'L AGGREGATE LIMIT APPLIES PER: GENERAL AOOREOATE $2,000,000 POLICY PRO- JECT LOC PRODUCTS-COMPIOP AGO $2,000, AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 a c de X ANY AUTO BODILY INJURY IPer person} A OWNED AUTOS ONLY SCHEDULED N N 6048916 07/14/2017 07/1412018 BODILY INJURY(Peracddenl) AUTOS NON OWNED PROPERTY GAMAOE HIRED AUTOS ONLY AUTOS ONLY X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $5,000,000 A EXCESS LIAR CLAIMS-MADE N N 6048919 07/1412017 07114/2418 AwtFOATE $5.0DD,000 DIED I RETENTION WORKERS COMPENSATION OTH- ANO EMPLOYERS'LIABILITY X PER STATUTE ER Y/SI ANY PROPR IETORIPART N ERIE XECUTIVE E,L EACH ACCIDENT $1,000,000 A OFFICERIMEMBER EXCLUDED? NIA N 6048920 0711412017 0711412018 E.L.DISEASE-EA EMPLOYEE (Mandatary In NH) $1,000,000 U yes,describe Under DESCRIPTION OF OPERATIONS beIGw El DISEASE-POLICY UMIT $1 sDD0 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addl II®nal Remarks Schodule,may be attached II more space Is requl red) CERTIFICATE€4OLDER CANCELLATION 252-856-0 361 ORANGE COUNTY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PO 89X 8181 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN HILLSBOROUGH,NC 27278-8181 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE � Q 1986-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD