2012-279 DEAPR - Recreation Factory Partners LLC for Sportsplex Management Fees $140,388

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OP ID: CH CERTIFICATE OF LIABILITY INSURANCE F (MM/DD/YYYY) o7116112 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(SI AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(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 endorsement ONT PRODUCER 910-455-7576 C ACT NAME: SIA Group 827 Gum Branch Rd. 910-455-7481 (PAHICONE FAX .No.Ext): (A/C,No): Jacksonville,NC 28540M00 E-MAIL Bradley Carroll-SIA assigned ADDRESS: PRODUCER cusTomERID*.RECRE-3 INSURERS)AFFORDING COVERAGE NAIC INSURED Recreation Factory Partners, INSURER A:National Casualty LLC DBA Triangle Sports Plex INSURER 8:Carolina Mutual Ins.Co. 14090 101 Meadowlands Drive Hillsbourough,NC 27278 INSURER C:Travelers 19070 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 IC 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. INSR TYPE OF INSURANCE ADDL SUBIR POLICY EFF POLICY XP LTR INISR-Wa POLICY NUMBER (MM)DONYYY) (MMIDDNM) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,0001 A X COMMERCIAL GENERAL LIABILITY X KK00000001463800 12(15111 12115/12 PREMISES Ee occurrence) $ 300,001 CLAIMS-MADE F—v-1 I OCCUR MED EXP(My one person) $ 5,00q PERSONAL&ADV INJURY $ 1,000,001 GENERAL AGGREGATE $ non( GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 C I POLICYF—]JERCof F]LOC Emp Ben. $ 1,000,00C AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT C X ANYAUTO BA-3423PI16-11-SEL 12JI9111 12/19/12 (Ea accident) $ 1,000,00C BODILY INJURY(Perperson) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) $ NON-OWNED AUTOS $ F1 $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAR CLAIMS-MADE XK00000001 464000 12J15111 12/15/12 AGGREGATE $ DEDUCTIBLE $ X RETENTION $ 0 $ WORKERS COMPENSATION X WC ST AND EMPLOYERS'LIABILITY YIN TORY ER B ANY PROPRIETOR/PARTNERfExECUTIVE WC161602011 12(28111 12/28(12 E.L.EACH ACCIDENT $ 1,0()0,000 OFFICERIMEMBER EXCLUDED? ❑ NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,desonbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS IVEHICLES (Attach ACORD 101,Additional Remarks Schedule,ifmoro space Is required) CERTIFICATE HOLDER CANCELLATION ORANG09 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO BOX ORANGE COUNTY ACCORDANCE WITH THE POLICY PROVISIONS. 8181 Hillsborough,NC 27278 AUTHORIZED REPRESENTATIVE 071988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD I I -