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DocuSign Envelope ID:2A1075EC-EE19-45F1-824C-C040EDA1A3FF
<br /> .-- CAROGRE-01 NSMITH
<br /> ��'��►�" DATE{MMlDDlYYYY}
<br /> CERTIFICATE OF LIABILITY INSURANCE EJMM/DDN
<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 pollcy{ios)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 License#'1000009384 NAME:
<br /> Hub International Southeast PaHIa°Nr Ext;($Ot))849 8008 arc N*;(704}334-6526
<br /> 1001 Morehead Square Drive,Suite 400 E-MAIL
<br /> Charlotte,NC 28203.0013 ADDRESS: _
<br /> INSURER(S)AFFORDING COVERAGE NAtC N
<br /> INSURER A:West American Insurance Co 44393
<br /> INSURED INSURERt3:Westfield Companies
<br /> Carolina Green Corp. INSURER C:Accident Fund General Insurance Company 12304
<br /> Kerry Price
<br /> 10108 Indian Trail-Fairview Rd INSURER o
<br /> Indian Trail,NC 28079 INSURERE:
<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 TYPE OF INSURANCE POLICY EFF PWDD EXP LIMITS
<br /> LTR INSR WVO POLICY MM(DDIYYYY MMtDDlYYYY
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE o OCCUR TRA4917720 0810112015 0810112016 PREMISES Ea'occu reence- $ 500,000
<br /> MED EXP(Anyone person) $ 10,000
<br /> PERSONAL&ADV INJURY $ m 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY N PRO, 0 LOC PRODUCTS-COMPIOPAGG S 2,000,000
<br /> JECT
<br /> OTHER: S
<br /> AUTOMOBILE LIABILITY =BIN1DIStNGLE LIMIT $ 1,000,000
<br /> B X ANY AUTO TRA4917720 0910112015 09/0112016 BODILY INJURY(Per person) $
<br /> ALL "'Ell SCHEDULED BODILY INJURY(Per actidenl) $
<br /> AUTOS AUTOS
<br /> X X NON-O'ANEO PROPERTY DAMAGE S
<br /> HIREDAI IDS AUTOS (Per accdent
<br /> UMBRELLA, X OCCUR EACHOCCURRENCE $ 51000,000
<br /> B EXCESS LIAR CLAIMS-MADE TRA4917720 09101/2015 0910112016 AGGREGATE $ 5,000,000
<br /> DED I X I RETENTIONS 0 S
<br /> WORKERS COMPENSATION
<br /> AND EMPLOYERS'LtABILtTY X S ATUTE ER"
<br /> C ANY PROPRIETOR/PARTNERIEXECUTIVE Y❑ NIA
<br /> CP1020510 09101/2015 09101/2016 EL,EACH ACCIDENT $ 1,000,000
<br /> OFFiCEM,IEMBER EXCLUDED?
<br /> (Mandatory in NH) EL.DISEASE-EAEMPLOYE S 1,000,000
<br /> iF yes,descnbe under
<br /> DESCRIPTION OF OPERATIONS betau EL.DISEASE-POLICY LIMIT $ 1,000,000
<br /> B Equipment Floater TRA4917720 09!0112015 0910112016 Leased/Rented 150,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS t VEHICLES(ACORD 104,Additional Remarks Schedule,may W attached It more spat*Is required)
<br /> RE: Field Construction and Irrigation Improvements,West Ton Soccer Center,Orange County,NC
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Orange County Government THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> F.O.BOX 8181 ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Hillsboro,NC 27278
<br /> AUTHORIZED REPRESENTATIVE
<br /> U 1988-2014 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2014101) The ACORD name and logo are registered marks Of ACORD
<br />
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