Orange County NC Website
DocuSign Envelope ID:9F4A9FCF-54CC-46AF-8928-75CFFCE670DO <br /> A v� CERTIFICATE OF LIABILITY INSURANCE DAT10/04/D/YYYY) <br /> 10/04/2018 <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 /> PHOE <br /> HOME OFFICE: P.O. BOX 328 A CNNo Ext:888-333-4949 (A 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 252-856-0 INSURER B:FEDERATED SERVICE INSURANCE COMPANY 28304 <br /> HARRIS BROTHERS ELECTRIC AND CONTROLS, INC. INSURER C: <br /> 2712 HILLSBOROUGH RD <br /> DURHAM, NC 27705-4044 INSURER D: <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:36 REVISION NUMBER:6 <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 MMIDDIYYYY MMIDDIYYYY <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 <br /> DAMAGE ToRENTED <br /> CLAIMS-MADE F OCCUR PREMISES Ea occurrence $100,000 <br /> ME EXP(Any one person) $5,000 <br /> A Y N 6048918 07/14/2018 07/14/2019 PERSONAL&ADV INJURY $1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 <br /> NOTHER: <br /> POLICY ❑SECT ❑LOC PRODUCTS-COMP/OP AGG $2,000,000 <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 <br /> Ea accident) <br /> X ANY AUTO BODILY INJURY(Per person) <br /> OWNED AUTOS ONLY SCHEDULED <br /> A AUTOS N N 6048918 07/14/2018 07/14/2019 BODILY INJURY(Per accident) <br /> HIRED AUTOS ONLY NON-OWNED PROPERTY DAMAGE <br /> AUTOS ONLY APer accident <br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $5,000,000 <br /> A EXCESS LIAB CLAIMS-MADE N N 6048919 07/14/2018 07/14/2019 AGGREGATE $5,000,000 <br /> DED I I RETENTION <br /> WORKERS COMPENSATION Y/N OTH- <br /> AND EMPLOYERS'LIABILITY X PER STATUTE ER <br /> ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $1 000 000 <br /> B OFFICERIMEMBER EXCLUDED? NIA N 6048920 07/14/2018 07/14/2019 <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1 000 000 <br /> If 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 if more space is required) <br /> THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS, LESSEES <br /> OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU ENDORSEMENT FOR GENERAL LIABILITY. <br /> CERTIFICATE HOLDER CANCELLATION <br /> 252-856-0 366 <br /> ORANGE COUNTY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> PO BOX 8181 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> HILLSBOROUGH, NC 27278-8181 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> © 1988-2015 ACORD CORPORATION.All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />