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DocuSign Envelope ID: 8B000D14- 2ECC -477A- 9407- A94C9CA16D86
<br />CAR❑GRE -01
<br />ICLARK
<br />'41 Rp� CERTIFICATE OF LIABILITY INSURANCE
<br />COVERAGES CERTIFICATE NUMBER: RFVISInNI KIIIM13ER•
<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 />DATE MIDPI
<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
<br />A TACT
<br />E•
<br />Cope Little Insurance
<br />14045 Bailantyne Corporate Place
<br />Suite 375
<br />Charlotte, NC 25277
<br />PHONE FAX
<br />AIC, No, Extl: 980) 406 -5988 AID No1;(704) 943 -0692
<br />EA &AIL , customerservice@lclirrn.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A: Builders Mutual Ins Co
<br />10844
<br />EACH OCCURRENCE
<br />INSURED
<br />INSURER B -
<br />$ 500,000
<br />I INSURER C:
<br />S 5,000
<br />Carolina Green Corporation
<br />INSURER D:
<br />& ADV INJURY
<br />10108 Indian Trail Fairview Rd
<br />Indian Trail, NC 28079
<br />UR R
<br />_PERSONAL
<br />GENERAL AGGREGATE
<br />[iNSE
<br />SURER F: k
<br />PRODUCTS - COMPIOP AGG
<br />S 2,000,000
<br />COVERAGES CERTIFICATE NUMBER: RFVISInNI KIIIM13ER•
<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
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUBR
<br />POLICY NUMBER
<br />POLIGY EFF
<br />POLICY EXP
<br />LIMITS
<br />A
<br />X
<br />coMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE ❑x OCCUR
<br />CPP0072114
<br />1010112017
<br />1010112018
<br />EACH OCCURRENCE
<br />S 1,000,000
<br />DAMAGE TO RENTED
<br />$ 500,000
<br />MEO EXP (Any one person)
<br />S 5,000
<br />& ADV INJURY
<br />S 1,000,000
<br />GENT AGGREGATE LIMIT APPLIES PER:
<br />POLICY [X] P JEC0.T E LOC
<br />OTHER:
<br />_PERSONAL
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />PRODUCTS - COMPIOP AGG
<br />S 2,000,000
<br />Pesticide
<br />_
<br />1 $ 1,0001000
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />Al1RTO5 ONLY X NRrN0J1.OY
<br />i0CdI. Ded x Hired PD- $50,0{10
<br />PCA0016868
<br />1010112017
<br />10/0112018
<br />CO MBIINE D SINGLE LIMIT
<br />S 1,000,000
<br />X
<br />BODILY INJURY Per person)
<br />s
<br />BODILY INJURY P�rraccident
<br />S
<br />X
<br />Peer ecciaeYa! AMAGE
<br />S
<br />x
<br />5
<br />A
<br />X
<br />UMBRELLA LIAR
<br />EXCESS LIAB
<br />7C
<br />OCCUR
<br />CLAIMS -MADE
<br />UMBOD35850
<br />10/0112017
<br />1010112015
<br />EACH OCCURRENCE
<br />$ 6,000,000
<br />AGGREGATE
<br />5,000,000
<br />DED x RETENTIONS 1(1,000
<br />5
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' "ABILITY
<br />ANY PROPRIETORIPARTNERIEXECUTIVE YIN
<br />QFFICERrM �Ag�R EXCLUDED? N
<br />andatoryn NHI
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />N f A
<br />CP1042087 1010112017
<br />10/0112018
<br />x PER 01H-
<br />E.L. EACH ACCIDENT
<br />500,000
<br />E.L DISEASE -EA EMPLOYE
<br />500,000
<br />E.L DISEASE - POLICY LIMIT
<br />S 500,000
<br />A
<br />A
<br />Leased/Rented
<br />Contractor Equipment
<br />CPP0072114
<br />CPP0072114
<br />1010112017
<br />10/0112017
<br />1010112018
<br />1010112018
<br />Limit
<br />Limit
<br />240,000
<br />3,239,025
<br />DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES {ACORO 904, AddlS(onal Remarks Schedule, may be attached it mare space Is required)
<br />Orange County Dept. of Environment, Agriculture, Parks i
<br />Recreation
<br />4710 West Ten Road
<br />Efiand, NC 27243
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />.�P 4.--
<br />ACORD 25 (2016103) © 1988 -2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
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