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DocuSign Envelope ID:865881C3-FBC1-4A19-8098-B2B092F29435 188693 <br /> ® DATE(MMIDD/YYYY) <br /> AGGRO CERTIFICATE OF LIABILITY INSURANCE 3/31/2017 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. <br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT y <br /> NAME: Brittany Ervin <br /> Commercial Lines—800-366-8834 PHONE FAX <br /> (A/C.No,Beth 704-557-2185 ���; 866-332-3051 <br /> Wells Fargo Insurance Services USA, Inc E-MAIL <br /> ADDRESS: brittan •ervin wellsfar o.com <br /> 6100 Fairview Road INSURER(S)AFFORDING COVERAGE NAIC# <br /> Charlotte,NC 28210 INSURERA: Zurich American Insurance Co 16535 <br /> INSURED INSURER B: Commerce&Industry Insurance Company 19410 <br /> T.A.Loving Company <br /> INSURER C: <br /> 400 Patetown RD(27533) INSURER D: <br /> PO Drawer 919 INSURER E: <br /> Goldsboro NC 27350 INSURER F <br /> COVERAGES CERTIFICATE NUMBER: 11659636 REVISION NUMBER: See below <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS <br /> LTR INSD WVD POLICY NUMBER (MMIDD/YYYY) (MMIDDIYYYY) <br /> A )( COMMERCIAL GENERAL LIABILITY GLO 3521190-15 04/01/17 04/01/18 EACH OCCURRENCE $ 2,000,000 RE <br /> CLAIMS-MADE X OCCUR PREMISES O(Ea occurrence) $ 300,000 <br /> X Contractual MED EXP(Any one person) $ 10,000 <br /> X XCU,Indep Contr PERSONAL&ADV INJURY $ 2,000,000 <br /> GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 <br /> POLICY LX P78_ X LOC PRODUCTS-COMP/OP AGG $ 4,000,000 <br /> OTHER: S <br /> A AUTOMOBILE LIABILITY BAP 3521191-15 04/01/17 04/01/18 COMBINED SINGLE LIMIT $ 1,000,000 <br /> _ (Ea accident) <br /> X ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accident) S <br /> AUTOS ONLY AUTOS —. <br /> HIRED NON-OWNED PROPERTY DAMAGE <br /> X AUTOS ONLY X AUTOS ONLY (Per accident) $ <br /> $ <br /> B x UMBRELLA LIAB X OCCUR BE 060702978 04/01/17 04/01/18 EACH OCCURRENCE $ 25,000,000 <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ 25,000,000 <br /> DED RETENTION$ 5 <br /> A WORKERS COMPENSATION WC 3521189-15 04/01/17 04/01/18 X STATUTE ER <br /> AND EMPLOYERS'LIABILITY 1,000,000 <br /> ANYPROPRIETOR/PARTNER/EXECUTIVE YIN N/A E.L.EACH ACCIDENT $ _ <br /> OFFICER/MEMBEREXCLUDED? <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE 5 1,000,000 <br /> If yes,describe under 1,000,000 <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Project: Orange County Sportsplex Fieldhouse <br /> Orange County and CRA Associates are listed as additional insured with respects to General Liability when required by written contract regarding the <br /> above captioned project. <br /> CERTIFICATE HOLDER CANCELLATION <br /> Orange County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> PO Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Hillsborough,NC 27278 <br /> AUTHORIZED REPRESENTATIVE <br /> The ACORD name and logo are registered marks of ACORD ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016!03) 11111111111 gi 11111111111 11111111111 I II CYB tA03/000581/02/02/0/0/0/0" <br />