2014-495-E DEAPR - Royalwood Associates Inc. for gymnasium resurfacing $1,577

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DocuSign Envelope ID:86E41720-BEF1-4F9E-BEE4-8D52A9AF1016 ROYAL-5 OP ID: RE CERTIFICATE OF LIABILITY INSURANCE DATE 09/0 `/2014 0 910 412 0 1 4 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(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcy(les) 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 endorsemont(s). PRODUCER CONTACT Tammy Coolidge Senn Dunn-Raleigh PoN FAX 4700 Falls of Neuse Rd,St 190 Arc Na Em:919-719-9_861 Arc No): 919-372-3716 Raleigh,NC 27609-2621 E-FRAIL tcoolid a SenndUnF1.COEn James P.Lowrey ADDRESS: 9 INSURERISI AFFORDING COVERAGE NAIC N _INSURE_RA:8olective Insurance Co of Amer 12572 INSURED Royalwood Associates,Inc, INSURERB;Builders Mutual Ins.Co. 10844 Attn: Don Eidson — --- P.O. Box 91145 INSURER C: Raleigh, NC 27675-1145 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIE=S OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD 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. ILTR TYPE OF INSURANCE INSR$C3E3si POLICY MNttIDIDYNYYY MMIDoIYYYY LIMBS GENERAL LIABILITY I EACHOCCURRENCE $ 1,000,00 A X COMMERCIAtGENERAL LIAR ILITY X 51931429 04/01/2014 04101/2015 DAMAGE TO RENTED PREMISES(Ea occurrence 5 100,00 CLAWS-MADE I X I OCCUR MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY 5 1,000,00 9ENERAL_A AGATE $ 3,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMPlOP AGG S 3,000,00 POLICY X PR0. LOC S AUTOMOBILE LIABILITY COW31NED SINGLE LIMIT 1,000,00 I Eaaccidenl 5A ANY AUTO 51931429 04/01/2014 04/0112015 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(per accident) $ HIREDAUT05 NON-OVJNPD PROPERTYOAh4AGE $ AUTOS PER ACCIDENT X UMBRELLA LIAB X OCCUR EACHOCCURRENCE $ 5,000,00 A EXCESS LIAR CLAIMS-MADE 51931429 04!0112014 04101/2015 AGGREGATE s 5,000,00 ❑Et} I X I RETENTION S 0 WORKERS COMPENSATION X 45'CSTATU- OTH- AND EMPLOYERS'LIABILITY Y LIF E B ANY PROPMETORIPARTNERIEXECUTWEYIN WCP102439601 0410'112014 04101/2016 _FLEACHACCIDFNT 5 1,000,00 OFFICERW EMBER EXCLUDE 07 NIA - ---- 1Mandatory lnNH) E.LDISEASE-EAEMPLOYE $ 1,000,00 It yyes,descrl6o under on OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,AddAlonal Remarks Schedule,it more space Is required) Re: Central Recreation Gymnasium Orange County is included as additional insured for General Liability as required by written contract. CERTIFICATE HOLDER CANCELLATION ORAN131 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE: THEREOF, NOTICE WILL BE DELIVERED IN Orange County ACCORDANCE WITH THE POLICY PROVISIONS. Mr.Christopher A.Sousa 200 S.Cameron St, AUTHORIZED REPRESENTATIVE PO Box 818 y�/f Hillsborough, NC 27278 O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD