2017-133-E Planning - Foster Lake and Pond Management, Inc. for carp fence repairs on Lake Orange

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DocuSign Envelope ID: 1 F025F8B-ABFD-4B18-8665-3BD9C14F7E17 ARD® DATE(MMIDDlYYYY) `� CERTIFICATE OF LIABILITY INSURANCE 04/03/2017 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). PRODUCER CONTACT NAME' David Wright Baker&Associates,Inc PHONE Ell) I(A/c.No) (919)552-9035 (A Subsidiary of Capital Insurance) EMAIL ADDRESS- 707 N.Woodrow St. INSURER(S)AFFORDING COVERAGE NAIC II Fuquay-Varina NC 27526 INSURER A: Centra Mutual Insurance Company 20230 ENSURED INSURER B: Erie Insurance Exchange 26271 Foster Lake&Pond Management,Inc. INSURER C: PO Box 1294 INSURER 0: INSURER E: Garner NC 27529 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 MATH 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. tNSR A06L SUER POLICY EFF POLICY EXP I.TR TYPE OF INSURANCE INSO WVD POLICY NUMBER (MM/ODfYYYYt (MMIDDKYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1000000 CLAIMS-MADE X OCCUR PREMISES $ 300000 X Primary&Non-contributory MED EXP(Any one person) $ 10000 A N N CLP9579075 03/20/2017 03/20/2018 PERSONAL 8 ADV INJURY $ 1000000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2000000 POLICY Er. X LOC PRODUCTS-COMP/OP AGG $ 2000000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000 (Ea accident/ X ANY AUTO BODILY INJURY(Per person) $ A OWNED AUTOS ONLY AUTOS SCHEDULED N N BAP9579074 03/20/2017 03120/2018 BODILY INJURY Per accident) $ X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY /� AUTOS ONLY (Per accident) $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2000000 A EXCESS LIAB CLAIMS-MADE N N CXS9579076 03/20/2017 03/20/2018 AGGREGATE s 2000000 DED I I RETENTION S 10000 $ WORKERS AND X I S O ERS'L ABILIITY Y f N TATUTE I I ERA B OFFICER/MEMBER EXCLU D PROPRIETOR/PARTNER/EXECUTIVE © N/A E.L.EACH ACCIDENT $ 1000000 (Mandatory in NH) N 0877000189 03/20/2017 03/20/2018 If es,describe under E.L.DISEASE-EA EMPLOYEE $ 1000000 DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT $ 1000000 Rented/Leased Equipment A N N CLP9579075 03/20/2017 03/20/2018 500 deductible 25,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be enriched 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 Planning and Inspections Department ACCORDANCE WITH THE POLICY PROVISIONS. 131 W Margaret Lane AUTHORIZED REPRESENTATIVE I Hillsborough NC 27278 eAZ-Z1- (-311a Fax: Email: O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD25(2016/03) The ACORD name and logo are registered marks of ACORD