2015-167-E DEAPR - Carolina Green Corp. for athletic field work $13,000

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DocuSign Envelope ID:2CB2C6D6-2358-410B-9815-4D437A2495C7 CAROGRE-01 NSMITH CERTIFICATE OF LIABILITY INSURANCE DA 3/17120115 ) 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 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 cortificate holder In lieu of such endorsement(s). PRODUCER License#1000009384 NAME: Hub International Southeast PHONE 800 849-8008 No; 704 334 (1528 1001 Morehead Sgcare Drive,Suite 400 arc No Ext:( } ( } Charlotte,NC 28203.00'13 E-MAIL INSURER(S)AFFORDING COVERAGE NAIC p INSURER A:Westfield Companies INSURED INSURER B:Builders Mutual Insurance Company 10844 Carolina Green Corp. INSURER C: Kerry Price INSURER D; 10108 Indian Trail•Falrview Rd Indian Trail,NC 28079 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 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 DD BR POLICY EFF POLICY EXP LIMBS LTR INSD WVD POLICYNUMBER MM1DD1YYYY MWDDlYYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS MADE OCCUR TRA4917720 09/01/2014 09!0112018 PREMISES IEa oocurrence $ 500,000 MEO EXP(Any one person) S 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY[_X] PEiB ]LOC PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER: 1 $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000 Ea accident A X ANY AUTO TRA4917720 0910112014 09/01/2015 BODILY INJURY(Per person) $ ALL O"NED SCHEDULED BODILY INJURY{Per accident) S X AUTOS X NON-OWNED PROPERTY DAMAGE S __ HIREDAUTOS AUTOS Peraccidenl UMBRELLA LIAB X OCCUR EACH OCCURRENCC S 5,000,000 A EXCESS LIAB CLAIMS-MADE TRA4917720 09101/2014 09/012015 AGGREGATE S 5,000,000 DED I X I RETENTIONS 0 S WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY YIN STATUTE ER B ANY PROPRIETORIPARTNERIEXECUTiVE NIA CP1020610 09101/2014 0910112015 E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? (Mandatory€n NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,400 It yyes,desaibo under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 A Equipment Floater TRA4917720 09/0112014 09101/2015 Leased/Rented 150,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD i0t,Additlonal Remarks Schedule,may be attached If more apace Is requ€red) RE: Field Construction and Irrigation Improvements,West Ten Soccer Center,Orange County,NC CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCE=LLED BEFORE Orange Count Government THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g y ACCORDANCE WITH THE POLICY PROVISIONS. P.O.Box 8181 Hillsboro,NC 27278 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD