2017-363-E DEAPR - Foster Lake & Pond Management for Blackwood pond fish stocking

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DocuSign Envelope ID: BA2EF2A2-A990-444E-B191-242F333586EE ®AC R CERTIFICATE OF LIABILI TY INSURANCE DATE(MM/DD/YYYY)‘...../.- oa/o3/2017 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 ,JA/C•No Psi) I(Fa.Not (919)552-9035 (A Subsidiary of Capital Insurance) gppRss 707 N.Woodrow St. INSURER(S)AFFORDING COVERAGE NAIL 0 Fuquay-Varina NC 27526 INSURER A: Centra Mutual Insurance Company 20230 INSURED 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 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 Apbl SUER t.TR TYPE OF INSURANCE INSO WVn POLICY NUMBER POLICY EFF PDLICYEXP X {A1M/ppIYYYYi {MMlnDNYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1000000 CLAIMS-MADE X OCCUR DAMAGFf5RENTED 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 a ADV INJURY $ 1000000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2000000 POLICY n Ter- Ix LOC PRODUCTS-COMP/OP AGG $ 2000000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000 (Ea accident) X ANY AUTO BODILY INJURY(Per parson) $ A AUTOS OS ONLY AUTOSULED N N BAP9579074 03/20/2017 03/20/2018 BODILY INJURY(Per accident) $ X HIRED NON.04NED PROPERTY DAMAGE AUTOS ONLY X AUTOS ONLY (Par accident) $ 5 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2000000 A EXCESSLIAO CLAIMS-MADE N N CXS9579076 03/20/2017 03/20/2018 AGGREGATE $ 2000000 DED (RETENTIONS 10000 $ WORKERS COMPENSATION X I PER I I OTH• AND EMPLOYERS'LIABILITY I B OFFICER/A1EMB EXCLUDED?PROPRIETOR/PARTNER/EXECUTIVE ;-i N/A E.L.EACH ACCIDENT ER $ 1000000 (Mandatory in NH) I ► ) N 0877000189 03/20/2017 03/20/2018 11 es,daso ibe under E.L.DISEASE-EA EMPLOYEE $ 1000000 DESCRIPTION OF OPERATIONS betas E L.DISEASE-POLICY LIMIT $ 1000000 A Rented/Leased Equipment N N CLP9579075 03/20/2017 03/20/2018 500 deductible 25,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may bo atlashed 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 e671- L*7—Ce - Fax: Email: O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD25(2016/03) The ACORD name and logo are registered marks of ACORD