Orange County NC Website
DocuSign Envelope ID: B65A93BB-6378-42A0-8340-F9CDBA5AA4BB <br /> ACORO- ® DATE(MM/DD/YYW) <br /> 16. CERTIFICATE OF LIABILITY INSURANCE 12/14/2018 <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 BELOW. THIS <br /> CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR <br /> PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If <br /> SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this <br /> certificate does not confer rights to the certificate holder in lieu of such endorsements. <br /> PRODUCER CONTACT <br /> FEDERATED MUTUAL INSURANCE COMPANY NAME: CLIENT CONTACT CENTER <br /> HOME OFFICE: P.O. BOX 328 (A/C,No Ext:888-333-4949 n/c No):507-446-4664 <br /> OWATONNA, MN 55060 E-MAIL <br /> ADDRESS:CLIENTCONTACTCENTER FEDINS.COM <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 <br /> INSURED 352-548-2 INSURER B: <br /> D W EVANS ELECTRIC INC INSURER C: <br /> 3511 EVANS CORPORATE LN <br /> DURHAM, NC 27705-7981 INSURER D: <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:85 r REVISION NUMBER:0 <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, EXCLUSIONS <br /> AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS <br /> LTR INSR WVD MM/DDIYYYY MM/DDIYYYY <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 <br /> DAMAGE TD <br /> CLAIMS-MADE �OCCUR PREMISES OEa oct uErrence $100,000 <br /> MED EXP(Any one person) EXCLUDED <br /> A N N 9171304 07/01/2018 07/01/2019 PERSONAL&ADV INJURY $1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 <br /> PRO- <br /> X POLICY JECT ❑LOC PRODUCTS-COMP/OP AGG $2,000,000 <br /> OTHER: <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 <br /> Ea accident <br /> X ANY AUTO BODILY INJURY(Per person) <br /> OWNED AUTOS SCHEDULED <br /> A ONLY <br /> A AUTOS N N 9171304 07/01/2018 07/01/2019 BODILY INJURY(Per accident) <br /> NON-OWNED <br /> HIRED AUTOS ONLY <br /> AUTOS ONLY PROPERTY DAMAGE <br /> Per accident <br /> X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $8,000,000 <br /> A EXCESS LIAB CLAIMS-MADE N N 9171306 07/01/2018 07/01/2019 AGGREGATE $8,000,000 <br /> DED RETENTION <br /> WORKERS COMPENSATION OTH- <br /> AND EMPLOYERS'LIABILITY Y/N X PER STATUTE ER <br /> E.L.EACH ACCIDENT <br /> ANY PROPRIETOR/EXCLUDRI;XECUTIVE ❑NIA N 9171307 07/01/2018 07/01/2019 $1,000,000 <br /> A (Mandatory <br /> in H EXCLUDED. E.L.DISEASE-EA EMPLOYEE 1,000,000 <br /> (Mandatory in NH) $ <br /> It yes,describe under <br /> DESCRIPTION OF OPERATIONS below E. DISEASE-POLICY LIMIT $1,000,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> 352-548-2 85 0 <br /> ORANGE COUNTY SOLID WASTE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> 1514 EUBANKS RD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> CHAPEL HILL, NC 27516-8124 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> O 1988-2015 ACORD CORPORATION.All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD <br />