2016-753-E AMS - Harris Bros charging station

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DocuSign Envelope ID:3946EAOB-95B2-4D15-A709-9F4B732AC5E3 AC DATE(MWODNYYY] �_. CERTIFICATE OF LIABILITY INSURANCE9/S/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 polloy(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 andorsement s. PRODUCER CONTACT Debby Blanchard Glick & Mahan Agency PHONE 11, (336)228-0525-- '— t Nol:(336)229-0900 2326 South Church St. E-MAIL ADDRESS:Jmldnchd3@nationwide.corlt Ste G INSURER AFFQ11 NG COVERAGE NAIC 0 Burlington NC 27215 WSURERA:DONEGAL INSURANCE GROUP 1-1-3-692 _ INSURED INSURER a; HARRIS BROTHERS ELECTRIC AND CONTROLS INC INSURER C: 2712 HILLSBOROUGH ROAD INSURER D: INSURER E: DURHM NC 27705 1 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. .....—.._..._....---- — ---- _._..----—---......-- ---............ 1011 AQDL SIUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MWDOIYYYY MNUDDfYYYY LIMITS X I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 -' -b�AGEtETqu - CLAIMS-MADE 51 OCCUR -PREMISES(Ea vc $ 100,000 CV989255.39 07/14/2026 07/14/2017 M_EDEX_P(Any oneperson) $ 5,000 A - -- -PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY u JRGT u LOC PRODUCTS-COMPIOP AGG $ 2,000,000 '.OTHER! ...--- $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea aoddant)- x ANY AUTO BODILY INJURY(Per parson} S ALL OWNED ^- SCHEDULED CA8925539 07./14/2016 07/14/2017 BODILY INJURY(Per accident) S AUTOS IAUTOS _ A NON-OWNED PROPERTY DAAMAGE X HIREO AUTOS AUTOS (per accklent $ I ...- S }C UMBRELLA LIAR 3x OCCUR t EACH OCCURRENCE s sr 00ne.00v ...--- - ---................._........ .....,. A — LXGESSLIAS CLAIMS_MADE CX8925539 07/14/2016 07/14/2017 AGGREGATE $ 5.000 000 WD RETENTIONS $ WORKERS COMPENSATION �x PER OTH AND EMPLOYERS'LIABILITY` __ STATUTE ER ANY PROPRIETCRIPARTNERIEXECUTIVE Y NIA IN C$925539 07142tl16 07142017 Ek EACH ACCIDENT $ 1,000,000 OFFICEWMEMBER EXCLUDED? ` l (Mandatory In NH) EL DISEASE-EA EMPLOYE S 1,000,000 If yes,desr.OW under - --- DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION abaznes@ol'angecountync,gow 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 paon� e 19.,is•2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)