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CAROGRE-01 NSMITH <br /> ACORU" DATE(MM/DD/YYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE 2/26/2014 <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 be endorsed. If SUBROGATION IS WAIVED,subject to <br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT <br /> NAME: <br /> Hub International Southeast PHONE 1 704 375-8000 166 FAX No; 1 704 334-6526 <br /> 1001 Morehead Square Drive Suite 400 A/C No Ell: ) ( ) <br /> Charlotte,NC 28203-0013 ADDRESS: <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A:Westfield Insurance Company 24112 <br /> INSURED INSURER B:Builders Mutual Insurance Company 10844 <br /> Carolina Green Corp. INSURERC: <br /> 10108 Indian Trail-Fairview Road INSURER D: <br /> Indian Trail,NC 28079 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 ADDLSUBR POLICY EFF POLICY EXP LIMITS <br /> LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 <br /> • X COMMERCIAL GENERAL LIABILITY TRA4917720 9/1/2013 9/1/2014 PREMISES Ea occurrence $ 100,00 <br /> CLAIMS-MADE OCCUR MED EXP(Any one person) $ 5,00 <br /> PERSONAL&ADV INJURY $ 1,000,00 <br /> GENERAL AGGREGATE $ 2,000,00 <br /> GEML AGGREGATE LIMIT APPLIES PER'. PRODUCTS-COMP/OP AGG $ 2,000,00 <br /> POLICY X PRO LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,00 <br /> Ea accident $ <br /> • X ANY AUTO TRA4917720 9/1/2013 9/1/2014 BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> NON-OWNED PROPERTY DAMAGE $ <br /> HIRED AUTOS AUTOS Per accident <br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,00 <br /> A EXCESS LIAB CLAIMS-MADE TRA4917720 9/1/2013 9/1/2014 AGGREGATE $ 5,000,00 <br /> DED I X I RETENTION$ $ <br /> TH- <br /> WORKERS COMPENSATION X WC STA O <br /> AND EMPLOYERS'LIABILITY TORY LIMIT TS ER R <br /> B ANY PROPRIETOR/PARTNER/EXECUTIVE YIN <br /> CP1020510 9/1/2013 911/2014 E.L.EACH ACCIDENT $ 1,000,00 <br /> OFFICER/MEMBER EXCLUDED? ❑ N/A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 <br /> If yes,describe under 1,000,00 <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> A Equipment Floater TRA4917720 9/1/2013 911/2014 Leased/Rented 150,00 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Orange County Parks&Rec. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Attn:Curt Farmer <br /> 6823 Millhouse Rd. <br /> Chapel Hill,NC 27516 AUTHORIZED REPRESENTATIVE <br /> �� <br /> 11 ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD <br />