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DocuSign Envelope ID:7D69FBBF-740D-461 F-894A-506C56B8C2AA <br /> NATIONWIDE MUTUAL INSURANCE COMPANY 80403 <br /> ONE NATIONWIDE PLAZA RENEWAL <br /> COLUMBUS,OH 43215-2220 <br /> COMMERCIAL GENERAL LIABILITY DECLARATIONS <br /> citdt'.Ks; 32A€J GLEN ROYAL RD 5TE iNC 2T61T-74S9 <br /> 13ALEI6H <br /> Agent: KEN LAWSON,JR. 32-80483-001 <br /> Address: RAL.EIGH NC 276116 PriODLJCER: KENNETH B LAWSON JR <br /> Policy Period; From 0212211s to 02/22117 1201 A.M,standard tlma at the address of the named Insured as stated <br /> herain, <br /> In return for the payment of the premium:,and subject Ia all the terms of this policy,we agree with you to provide the <br /> Insuranoe as stated In thls policy.- <br /> GENERAL AGGREGATE LIMIT {otharfhera�iroducts-tom feted operations) $ 21000i0001 <br /> PRODDUCT"OMPLETED OPEfil#TIONS ACG'REGATE LIMIT 21000:000 <br /> PERSONAL AND ADVERTISING INJURY LIMIT � 1,000,00 <br /> EACH t?CCU'RRENCE LIMIT <br /> DAMAGE TO PREMISES RENTED TO YOU LIMIT(any one premises) tI &,000 <br /> MEDICAL CXPI NSF LIMIT'(any one person) <br /> 000 <br /> . ............................:w..,,m.,..,.......... <br /> .. <br /> G Date{Ct�only) <br /> Retroactivea -- ,..mww,,,-,.�,,. . ,,.. ....,,�......�.,...,,.�....,...,,,,.,,�,,.............�,,..... <br /> The-Nerned Insured is; ORPORATION <br /> Business of the blamed Insured is: ELECTRICAL APPARATUS <br /> Audit Period.: ANNUAL _ <br /> hIEJCSf SEMI i+1TS ATTACHED TU THIS POLICY <br /> SEE COMMERCIAL,GENERAL LIABILITY FORMS AND ENDORSEMENTS SCHEDULE <br /> TOTAL ADVANCE PREMIUM <br /> Replacement or <br /> Renewal Number ACP GLO 2262094383 ' <br /> A PACKAGE MODIFICATION FACTOR HAS BEEN APPLIED � <br /> CGt+nterslgnedl By f ,.._t .... .......... <br /> mAurl 37 Opr �i�1al�v t' <br /> GL-0;10-08= <br /> DMEC7 KILL LOW M08 AGENT COPY ACP GLO 2272ON393 437701411 22 00072N <br />