2018-321-E DEAPR - Foster Lake and Pond pond maintenance

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DocuSign Envelope ID: C206F6A9 -53F5- 4421- 917D- F7312D7B37F8 ACC]R °� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIMYYYY) 07/16{2018 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 endorsements), PRODUCER Baker &Associates, Inc o rA Subsidiary f Ca. ital Insurance) i p 1 707 N. Woodrow St, Fu ua - Varina NC 27526 COOMIACT David Wright PHONE (919L571-0685 F No (919)571-0684 E -DMIML - - CRESS:__ _ INSURERS AFFORDING COVERAGE NAIC # INSURERA: Central Mutual Insurance Com n 20230 INSURED Faster Lake & Pond Management, Inc• pQ Box 1294 Gamer NO 27529 INSURER B: Erie Insurance Exchange a 26271 INSURER C' 03/20/2019 INSURER D: T $ 1000ODD INSURER E: REMISES fEa occurrence INSURER F: X COVERAGES CERTIFICATE NUMBE=R: REVISION NdHMRFR• 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. INGR LTR TYPEOFINSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP r Y LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR primary & Non - contributory Y N CLP9579075 03/2012018 03/20/2019 EACH OCCURRENCE $ 1000ODD REMISES fEa occurrence $ 300000 - - X MED EXP (Anyone parson) $ 10000 PERSONAL &ADVINJURY $ 1000000 GENT AGGREGATE LIMIT APPLIES PER: POLICY El O JEGPRT 191 LOG OTHER: GENERAL AGGREGATE $ 2000000 PROaUGTS- COMPIOPAGG $ 2000000 $ A AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED+ NON-OWNED AUTOS ONLY AUTOS ONLY N N BAP9579074 03120/2018 0312012019 COMBINED SINGLE LIMIT Ea accrdenl $ 1000000 BODILYINJURY (Pa rperson) $ BODILY INJURY (Peraccidenl D $ PROPERTY DAMAGE Paraccidenl $ $ A X UMBRELLA LIAR EXCESSLIA$ X OCCUR CLAWS -MADE N N 0X59579076 03 /2012018 03/20/2019 EACH OCCURRENCE $ 2000000 AGGREGATE $ 2000000 DED I I RETENTION 10D00 $ B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANY PRO PHI ETORIPARTNERIEXECUTIVE OFFICERrMEMBER EXCLUDED? (Mandatory in NH) Ifyes, doserfbe under DESCRIPTION OF OPERATIONS below NIA N QB 7000189 03120/2018 03f2012019 PER OTH- X UTE ER E.L EACH ACCIDENT $ 1000000 E.L. DISEASE - EA EMPLOYEE $ 1000000 E. L, DISEASE - YOLIGY LIMIT $ 1000000 A Rented/Leased Equipment N N ClP'9579075 03/20/2018 03/20/2019 500 deductible 25,000 OESCRtPTION OF OPERATION$ I LOCATIONS /VEHICLES (ACORD 101,Addltlonal Remarks Schedule, may beatlached If morespece Is rNufred) Orange County is an additional insured With respects to the general liability coverage. rlyiLiR!Jy &i SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Orange County ACCORDANCE MOTH THE POLICY PROVISIONS. Blackvvood Farm Park 4215 NO 86 AUTHORIZED REPRESENTATIVE Fax: Finail' n IQQR IMF Arnan rnoonrsnrrr hI Arr ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD