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DocuSign Envelope ID:84061484-66C3-4BCA-9FFF-FO9ACOA0012D <br /> ncoRn <br /> CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) <br /> F02/01/2022 <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 <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED <br /> REPRESENTATIVE OR 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. <br /> If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on <br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br /> ONTACT Kathryn L Mla <br /> PRODUCER C <br /> Bright Owl Insurance PHONE 828 884-3670 nX 828 966-9684 <br /> 11OA Oakdale Street EA <br /> -MIL brightowlinsurance@gmail.com <br /> Brevard NC 28712 INSURERS AFFORDING COVERAGE NAIC# <br /> INSURER A: Evanston Insurance Company <br /> INSURED INSURER B: Evanston Insurance Company <br /> Pineshore Energy LLC INSURER C: Inte on National <br /> PO Box 443 INSURER D: <br /> Brevard NC 28712 INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <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, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP <br /> LTR la POLICY NUMBER LIMITS <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> A X1 CLAIMS-MADE OCCUR DAMAGE TO RENTED $ 100,000 <br /> MKLV7PE0002150 01/13/2022 01/13/2023 MED EXP(Any oneperson) $ 10,000 <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000 <br /> X POLICY PRO- ❑ LOC PRODUCTS-COMP/OP AGG $ 1,000,000 <br /> JECT <br /> OTHER: Electronic Media Lia $ 1,000,000 <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $750,000 <br /> C ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED X SCHEDULED AUTOS ONLY AUTOS 2010838663 12/08/2021 12/08/2022 BODILY INJURY(Per accident) $ <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY ccidna <br /> UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED I I RETENTION $ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY Y/N FR <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE❑ N/A E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> B Professional Liability MKLV7PE0002150 01/13/2022 01/13/2023 1,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Engineering software and hardware for electronic vehicle stations <br /> CERTIFICATE HOLDER CANCELLATION <br /> Orange County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> PO Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Hillsborough NC 27278 <br /> AUTHORIZED REPRESENTATIVE <DA> <br /> V <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />