2016-308-E DEAPR - Eastern Turf Maintenance, Inc. for soccer field maintenance

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DocuSign Envelope ID: 723772BB-F58B-41 CC-ADE9-3136393491 F1 AC'©® DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 5/17/2016 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 endorsement(s). PRODUCER CONTACT Patty Miller NAME:Business Insurers of Carolinas PHONE o.Ex1}`(919)968-4611 FAX Na); P (919)968-8991 800 Eastowne Drive, Suite 208 MAIL miller @business-insurers,com mmusS: PO Box 2536 INSURER(S)AFFORDING COVERAGE NAIC II Chapel Hill NC 27515-2536 INSURERA:Penn National Security 32441 INSURED INSURERB:Penn National Mutual Casualty 14990 EASTERN TURF MAINTENANCE INC INsuRERCAccident Fund National Ins Co. 12305 3305 ANVIL PL INSURER D: INSURER E: RALEIGH NC 27603-3514 INSURER F COVERAGES CERTIFICATE NUMBER:16-17 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS ,LTR INSD WVO_ POLICY NUMBER IM1UDDIYYYYI IMMJDD!YYYYI_ X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000 OCCUR PREMIS ESIEaoccu TO RENTED A CLAIMS-MADE X 100,000 PREMISES 5 CX9 0727704 3/15/2016 3/15/2017 MED EXP(Arty one person) $ 5,000 PERSONAL BADVINJURY $ 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: _GENERAL AGGREGATE $ 2,000,000 X POLICY X JE f LOG PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 A X ANY AUTO BODILY INJURY(Per person} $ X ALL OVAED © ) SCHEDULED AX9 0727704 3/15/2016 3/15/2017 BODILY INJURY(Per accident $ AUTOS AUTOS X NON-OWNED PROPERTY DAMAGE HIRED AUTOS Ma AUTOS (Per accident) Underinsured motorist $ X UMBRELLA LIAB X OCCUR UL90727704 EACH OCCURRENCE S 3,000,000 B EXCESS LIAB CLAIMS-MADE AGGREGATE $ 3,000,000 DED X RETENTIONS 10,000 3/15/2016 3/15/2017 S WORKERS COMPENSATION X PER I OTH- AND EMPLOYERS'LIABILITY STATUTE J -ER _ ANY PROPRIETOR/PARTNER/EXECUTIVE Y!N WCV 6124200 E.L.EACH ACCIDENT $ 1,000,000 C OFFICER/MEM,4BEREXCLUDED? y NIA 3/15/2016 3/15/2017 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE 6 1�,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 A Leased Rented Equipment CX9 0727704 3/15/2016 3/15/2017 560,000 limit ACV $500 deduct DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule.may be attached If more space Is required) RE: Soccer Center CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County DEAPR THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Lori Taft, CPRP,M.ED ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 8181 Hillsborough, NC 27278 AUTHORIZEO REPRESENTATIVE Patty Miller/PATTY ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS0251701451t