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DocuSign Envelope ID: CEOEA8D1- 92A1 -4F64- 8637- 8AEBB473EOC4 <br />ACC >RL? CERTIFICATE OF LIABILITY INSURANCE <br />DA4S18I2 ©�Y$YY) <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />NAME David David Wright <br />Baker & Associates, I nc <br />(A Subsidiary of Capital Insurance) <br />rAX <br />P IIO_IE Ext 919) 571 -0685 WC No 919 571 -0684 <br />E-MAIL SS <br />INSURERS AFFORDING COVERAGE <br />NAIC z <br />707 N- Woodrow St. <br />INSURERA Central Mutual Insurance Company <br />20230 <br />Fuqua - Varina NC 27526 <br />INS( -RE-) <br />INSURER B : Erie Insurance Exchange <br />26271 <br />INSURER C <br />Foster Lake & Pond Management, I nc. <br />INSURER D: <br />PC BCD< 1294 <br />INSURER E <br />DAMAGE TO RENTED <br />PREMISES aoccurrence <br />$ 300000 <br />INSURER F <br />MED EXP (Anyone person) <br />Garner INC 27529 <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <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 />1-TR <br />TYPE OFINSURANCE <br />ADDL <br />SUBR <br />POLICY NUMBER <br />POLICY EFF <br />POLICY EXP <br />- <br />LIMITS <br />X <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1000000 <br />CLAIMS-MADE ® OCCUR <br />DAMAGE TO RENTED <br />PREMISES aoccurrence <br />$ 300000 <br />X <br />MED EXP (Anyone person) <br />$ 10000 <br />Primary & Non - contributory <br />PERSONAL &ADV INJURY <br />$ 1000000 <br />A <br />Y <br />N <br />CLP9579075 <br />03/20/2018 <br />03)2012019 <br />GEN'L AGGREGATE LIMIT APPLIES PER, <br />GENERAL AGGREGATE <br />$ 2000000 <br />POLICY PRO- <br />JECT X LOC <br />PRODUCTS - COMP +OP AGG <br />$ 2000000 <br />$ <br />OTHER: <br />I <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT Ea acciden <br />$ 1accident) <br />X <br />BODILY INJURY (Per person) <br />$ <br />ANYAUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />N <br />N <br />BAP9579074 <br />031201201$ <br />03i20l2Q1 <br />SODILY INJURY (PeraCCdgnl) <br />$ <br />X <br />PROPERTYr]Ar�AGE <br />Par accident <br />HIRED X NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />X <br />UMBRELLA LIAB <br />X <br />OCCUR <br />EACH OCCURRENCE <br />$ 2000000 <br />AGGREGATE <br />$ 2000000 <br />A <br />EXCESS LIAB <br />CLAIMS -MADE <br />N <br />N <br />CXS9579076 <br />03/20/2018 <br />03202019 <br />DED I RETENTION 10000 <br />$ <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y ! N <br />ANY PRO PRIETOR'PARTNER)EXECUTIVE <br />OPFICER'MEMBER EXCLUDED? <br />(Mandatory in NH) <br />NIA <br />N <br />0877000189 <br />03/20/201$ <br />031"202019 <br />+/ <br />�^+ STATUTE ERH <br />E.L. EACH ACCIDENT <br />$ 1000000 <br />E.L. DISEASE - EA E6SP_DYEE <br />$ 1000000 <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L DISEASE - POLICY LIMIT <br />$ 1000000 <br />A <br />Rented/Leased Equipment <br />TN <br />N <br />CLP9579075 <br />03/20/2018 <br />03202019 <br />500 deductible <br />25.000 <br />.�)ESCRIPTION OF OPERATIONS LOCATIONS; VEHICLES (ACORD 101, Addi[mnal Remarks Schedule, may deattached if more space Is required) <br />ORANGE COUNTY is an additional insured with respect to the General Liability Policy <br />CERTIFICATE HOLDER CANCELLATION <br />Orange County Planning and Inspections Department <br />P O Box 8181 <br />131 W Margaret Lane <br />Fax- <br />ACORD 25 (2016103) <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 />ia�iisT# �► S�' ��FraTi7eliTiT ,•7elSfair7iiFil��:► .. - -. <br />The ACORD name and logo are registered marks of ACORD <br />