CERTIFICATE OF LIABILITY INSURANCE
Review draft in certificate field order. The certificate is issued from your AMS after approval.
Date (MM/DD/YYYY)10/30/2026
ProducerTriangle Demo Agency
Durham, NC
(919) 555-0142
Insurers affording coverage
INSURER AErie Insurance
INSURER BSelective
Insured
Haw River Electric LLC
37 Depot St
Graham, NC 27302
Certificate numberDRAFT-8408Revision number0
COVERAGES
| INSR LTR | TYPE OF INSURANCE | ADDL INSD | SUBR WVD | POLICY NUMBER | POLICY EFF | POLICY EXP | LIMITS |
|---|---|---|---|---|---|---|---|
| A | GENERAL LIABILITY | Y | Y | GL-4199525 | 12/02/2025 | 12/02/2026 | Each occurrence$1,000,000 Damage to rented premises$100,000 Med exp (any one person)$5,000 Personal and adv injury$1,000,000 |
| A | COMMERCIAL AUTO | Y | Y | CA-8772657 | 12/02/2025 | 12/02/2026 | Combined single limit (ea accident)$1,000,000 |
| B | WORKERS' COMP | N/A | Y | WC-8653192 | 12/02/2025 | 12/02/2026 | E.L. each accident$1,000,000 E.L. disease, each employee$1,000,000 E.L. disease, policy limit$1,000,000 |
| A | UMBRELLA | Y | N | UM-2948882 | 12/02/2025 | 12/02/2026 | Each occurrence$1,000,000 Aggregate$1,000,000 |
Description of operations / locations / vehicles
Certificate holder is included as Additional Insured and granted Waiver of Subrogation where required by written contract, subject to policy terms, conditions and exclusions.
General liability GL-4199525: Additional insured (CG 20 10); Waiver of transfer of rights of recovery (CG 24 04).
Commercial auto CA-8772657: Designated insured for covered autos liability (CA 20 48); Waiver of transfer of rights of recovery (CA 04 44).
Workers' comp WC-8653192: Waiver of our right to recover from others (WC 00 03 13).
Umbrella UM-2948882: Follow form (UMB FF).
Certificate holder
Bishop Brothers Development
Address needed
CancellationShould any of the above described policies be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy provisions.Authorized representativeSigned on approval