2016-608-E AMS - T.A. Loving Company for Sportsplex Field House pre-construction services

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DocuSign Envelope ID:826509CF-ED5F-4F89-AE19-18F10AF97036 r 1 APP N IX Certificate of Liability Insurance lacotra . AC®'?1 CERTIFICATE OF LIABILITY INSURANCE DATE DNYYYY) 3/31/2/31/2 015 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(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 Commercial Lines—800-366-8834 HAMS: Erika Henderson INC.No,Extl:704-556-2588 INC,No):866-332-3051 Wells Fargo Insurance Services USA,Inc E-MAIL erika,henderson wellsfar o com ADDRESS; 6100 Fairview Road INSURERS)AFFORDING COVERAGE NAIC M Charlotte,NC 28210 INSURER A: Zurich American Insurance Co 16535 INSURED INSURER e: Commerce&Industry Insurance Company 19410 T.A.Loving Company _INSURER c: 400 Patetown Road(27533) INSURER 0: P°Drawer 919 INSURER E: Goldsboro,NC 27350 INSURER F: COVERAGES CERTIFICATE NUMBER: 8942982 REVISION NUMBER: see below 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 ADDLBUBR POUCYEFF POUCYEXP INSD WvD POLICY NUMBER IMMIDDIYYYYI IMMIDD(YYYY) OMITS X COMMERCIAL GENERALUABIUTY A GL0352119013 04/01/15 04/01/16 EACH OCCURRENCE S 2,000,000 DAMAGE TO RENTED CLAIMS-MADE [x I OCCUR PREMISES lea occurrence) $ 300,000 X Contractual MED EXP(My one penal) S 10,000 _ X XCU,Indap Cone PERSONAL C.ADV INJURY S 2,000,000 GENL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE _S 4,000,000 POLICY I X I ET I^ I LOC PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER: S A AUTOMOBILE LIABILITY BAP352119113 04/01/15 04/01/16 CEe eOMBINED SINGLE LIMIT $ 1,000,000 _ Iccidenl) X ANY AUTO BODILY INJURY(Per person) S ALL OWNED —SCHEDULED BODILY INJURY Per accident) S AUTOS AUTOS ( ) — X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS War acddenn S S B X UMBRELLA UAB X OCCUR 13E048403250 04/01/15 04/01/16 EACH OCCURRENCE S 25,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE _5 25,000,000 DED I I RETENTION S S A WORKERS COMPENSATION AND EMPLOYERS'LIABIUTY Y IN STAT WC352118913 04/01/15 04/01/16 X I PER UTE EI I GTR H ANY PROPRIETORJPARTNERIEXECUTIVE I I N I A E.L.EACH ACCIDENT S 1,000,000 OFFICER/MEMBER EXCLUD£D7 (Mandatory In NH) E,L.DISEASE-EA EMPLOYEE S 1,000,000 II yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached It more apace le required) Evidence of Coverage CERTIFICATE HOLDER CANCELLATION T A Loving Company SHOULD ANY of THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 400 Patetown Road THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. P 0 Drawer 919 Goldsboro,NC 27533 AUTHORIZED REPRESENTATIVE 904.- 1 The ACORD name and logo are registered marks of ACORD m 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) 30 I