2017-362-E DEAPR - Foster Lake & Pond Management for pond management

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DocuSign Envelope ID:07B6B8E1-DC18-45B6-9B3D-79FB76B59CF6 ®Ac R CERTIFICATE OF LIABILITY INSURANCE DATEMDDIYYYY) fir,- 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 (A Subsidiary of Capital Insurance) E E-MAIL E'd1 I T .No) (919)552-9035 ADDRESS 707 N.Woodrow SL INSURER(S)AFFORDING COVERAGE NAIC 0 Fuquay-Varina NC 27526 INSURER A: Centra Mutual Insurance Company 20230 INSURED INSURER a: Erie Insurance Exchange 26271 Foster Lake&Pond Management,Inc. INSURER C: PO Box 1294 INSURER p 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 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 TOOL SUER POLICYEFF POLICYEXP LTR, TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMn)rwYYYY! (MMIDDA'YW) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1000000 CLAIMSADE I X OCCUR BA 1� "r0 RENTED •M ,PREMISES(Ea occurrence) $ 300000 X Primary&Non-contributory MED EXP(Any one person) $ 10000 A N N CLP9579075 03/20/2017 03/20/2018 PERSONAL&ADV INJURY $ 1000000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2000000 POLICY I I Ter X LOC PRODUCTS-COMP/OP AGG $ 2000000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000 (Ea aceklenD X ANY AUTO BODILY INJURY(Per person) $ OWNED - SCHEDULED N N BAP9579074 03/20/2017 03/20/2018 BODILY INJURY(Per accident) $ A AUTOS ONLY AUTOS X HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY X AUTOS ONLY (Per accident) $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2000000 A EXCESS LIAR CLAIMS-MADE N N CXS9579076 03/20/2017 03/20/2018 AGGREGATE $ 2000000 DED I I RETENTIONS 10000 $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y!N X I STATUTE I ER ANY B ICERrMEM E EXCLUDED?PROPRIETOR/PARTNER/EXECUTIVE ECUTIVE N/A E.L.EACH ACCIDENT g 1000000 I N 0877000189 03/20/2017 03/20/2018 (Mandatory in NIB EL.DISEASE•EA EMPLOYEE $ 1000000 II teas,doeUibe under 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 bo cinched it 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 _ (i(Ila'g4 - Fax: Email: O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD25(2016/03) The ACORD name and logo are registered marks of ACORD