2017-118-E DEAPR - Carolina Green Corp. for W10 spring renovation

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DocuSign Envelope ID: F8C68ECA-D485-4C2A-B772-05B284F5AADA CAROGRE-01 JCLARK '4�C�o,�zo CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDD(YYYY) 02/27/2017 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 have ADDITIONAL INSURED provisions or 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). CONTACT PRODUCER NAME: Lowry,Cope&Little PHONE 980 406-5988 FAx 704 943-0692 14045 Ballantyne Corporate Place (A/C.No,Ext):( ) (A/c,No):( ) Suite 375 E-MAIL SS:customerservice @lclirm.com Charlotte,NC 28277 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Builders Mutual Ins Co 10844 INSURED INSURER B:Great American Insurance Carolina Green Corporation INSURER C: 10108 Indian Trail Fairview Rd INSURER D: 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 ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM!DD/YYYYI (MM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR CPP0072114 10/01/2016 10/01/2017 DAMAGE TO RENTED 100,000 PREMISES(Ea occurrence) $ X Pesticide/Herbicide MED EXP(Any one person) $ 5,000 X $1,000,000 PERSONAL&ADV INJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 POLICY X PROT- LOC PRODUCTS-COMP/OPAGG $ 2,000,000 JEC OTHER: $ CO A AUTOMOBILE LIABILITY (Ea acccident )SINGLE LIMIT $ 1,000000 X ANY AUTO PCA0016868 10/01/2016 10/01/2017 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ X HIRED X NON-OWNED PR PERdTnt)AMAGE $ AUTOS ONLY AUTOS ONLY X Comp/Colt$1000 X Hired PD$50,000 A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE UMB0035850 10/01/2016 10/01/2017 AGGREGATE $ 5,000,000 DED X RETENTION$ 1 0,000 $TH- A WORKERS COMPENSATION X STATUTE _ 0TH AND EMPLOYERS'LIABILITY Y/N WCP1042087 10/01/2016 10/01/2017 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE N N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? 500,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Leased/Rented CPP0072114 10/01/2016 10/01/2017 Limit 100,000 B Installation IMP1538805 10/01/2016 10/01/2017 Limit 50,000 DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County Dept.of Environment,Agriculture,Parks& THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g Y p 9 ACCORDANCE WITH THE POLICY PROVISIONS. Recreation 4710 West Ten Road Efland,NC 27243 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD