2016-562-E DEAPR - Design Dimensions, Inc. - Amendment to extend end date for graphic design at Blackwood Farm Park

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DocuSign Envelope ID:2D2D9F9D-7378-4BE3-8983-58886E84466D AcoRO® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `../ 10/19/2015 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 certificate holder in lieu of such endorsement(s). PRODUCER CONTACT TRACY MEADOWS NAME: INSURE (NC.No,Extl: (919)781-1115 I (AAIC No): (919)783-6427 2607 GLENWOOD AVENUE E-MAIL ADDRESS:TADOWS @ INSURE-NC.COM PO BOX 31508 INSURER(S)AFFORDING COVERAGE NAIC# RALEIGH NC 27622 INSURERA:TRAVELERS INDEMNITY CO OF CT INSURED INSURER B:TRAVELERS CAS INS CO OF AMERICA DESIGN DIMENSION INC INSURER C TRAVELERS INDEMNITY COMPANY 901 NORTH WEST STREET INSURERD: RALEIGH NC 27603 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER:STD-15/16 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE k c ,A , POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES 300,000 (Ea occurrence) $ r 000 A CLAIMS-MADE X OCCUR I-660-7A930152-TCT-15 10/25/2015 10/25/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY n PRO- LOC $ JFCT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 B X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BA-7A387415-15-SEL 10/25/2015 10/25/2016 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS _ AUTOS (Per accident) _ Uninsured motorist combined $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE CUP-7A930336-15-42 10/25/2015 10/25/2016 AGGREGATE $ 1,000,000 C DED RETENTION$ $ C WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS I ER ANY ANYICEOPEIETOOR/PARTNER/E ECUTIVE N N/A E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in NH) IA-UB-7A38701-0-15 10/25/2015 10/25/2016 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION 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. DEPT OF ENVIRONMENT, AGRICULTURE, PARKS AND RECREATION AUTHORIZED REPRESENTATIVE AT TN PETER SANDBECK PO BOX 8181 1 HILLSBOROUGH, NC 27278 TRACY MEADOWS/TRACY ,___- Cr-(:#-C-4-1--- '---, ---"'"'"°.t 1 ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD