2017-471-E DEAPR - Eastern Turf Maintenance, Inc. to laser-grade infield

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( DocuSign Envelope ID:234B3AA9-0271-47A9-9E47-F16CA5F12253 ^CORD® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) `„-/ 8/29/2017 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 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 Patty Ptt Miller y er Business Insurers of Carolinas AIO No,Ext); (919)968-4611 FAAC Nol:(919)968-6991 800 Eastowne Drive, Suite 208 ADDRESS:pmiller @business-insurers.com PO Box 2536 INSURER(S)AFFORDING COVERAGE NAIC# Chapel Hill NC 27515-2536 INSURERA:Penn National Security 32441 INSURED INSURER B:Penn National Mutual Casualty 14990 EASTERN TURF MAINTENANCE INC INSURERCAccident Fund National Ins Co. 12305 3305 ANVIL PL INSURER D: INSURER E: RALEIGH NC 27603-3514 INSURERF: COVERAGES CERTIFICATE NUMBER:17-18 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 EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE _ $ 1,000,000 A CLAIMS-MADE X OCCUR PRMMGE TO RENTED 100,000 PREMISES(Ea occurrence) $ CX9 0727704 3/15/2017 3/15/2018 MED EXP(Any one person) $ 5,000 PERSONAL&ADVINJURY $ 1,000,000 GENII AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY X Ta LOC PRODUCTS-COMP/OP AGG_ $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ A _ ALL OWNED SCHEDULED X AUTOS X AUTOS AX9 0727704 3/15/2017 3/15/2018 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS (Per accident) _ $ - I Underinsured motorist - $ X UMBRELLALIAB X OCCUR UL90727704 EACH OCCURRENCE $ 3,000,000 B EXCESS LIAB CLAIMS-MADE AGGREGATE $ 3,000,000 DED X RETENTION 10,000 3/15/2017 3/15/2018 $ WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY Y/N STATUTE _OERH ANY PROPRIETOR/PARTNER/EXECUTIVE N/A WCV 6124200 E.L.EACH ACCIDENT $ 1,000,000 C (Mandatory In NH)EXCLUDED? y 3/15/2017 3/15/2018 ( ry ) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 A Leased Rented Equipment CX9 0727704 3/15/2018 3/15/2018 $60,000 Limit ACV $500 deduct '.... DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Job: Efland-Cheeks Park CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County DEAPR THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS. Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE Patty Miller/HSALAS ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS0 2 5 17014011