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DocuSign Envelope ID: 00697A59 -ECC2- 4038- BD04- 6AF22BEE4A87
<br />0
<br />A4CCW" . CERTIFICATE OF LIABILITY INSURANCE
<br />DATEIMMIDDIYYYY)
<br />7/3012018
<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 ENSURER(S)I, AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy( €es) 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 />Marsh & McLennan Agency LLC
<br />4740 Falls of Neuse Rd, St 190
<br />Raleigh NC 27609 -2521
<br />NAME: T Tammy L. Coolidge, CIC, CISR, ACSR
<br />PHONE FAX
<br />AK,1!P _E 819 719 -9861 c Mal: 212 -607 -6564
<br />ADORF$% Tammy,Cooiidge @marshmma.com
<br />INSURE S AFFORDING COVERAGE
<br />_ NAIC #
<br />INSURERA : Selective Ins Co of the SEast
<br />39926
<br />INSURED ROYAL -5
<br />Royalwood Associates, Inc.
<br />Attn: Don Eidson - CEO
<br />P. O. Box 91145
<br />Raleigh NC 27675 -1145
<br />INSURER B: Builders Mutual Ins. Co.
<br />10844
<br />INSURER C:
<br />41112019
<br />INSURER D:
<br />$ 1,000,000_
<br />INSURERE:
<br />IAGL T� R
<br />PREMISES Ea oocurrems
<br />INSURER F:
<br />r`nV1= r2AGES CERTIFICATE NUMBER: 666048544 REVISION NUMBER:
<br />Y 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 RCQUIREMENT, 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 />L7R
<br />TYPE OF INSURANCE
<br />AODLSUBii
<br />POUCYNUMBER
<br />MMIDDIYYYY
<br />MMIDYDIYYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE � OCCUR
<br />51931429
<br />W112018
<br />41112019
<br />EACH OCCURRENCE
<br />$ 1,000,000_
<br />IAGL T� R
<br />PREMISES Ea oocurrems
<br />$ 51 _0000
<br />MED EXP (Any one person)
<br />$ 16,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEVL AGGREGATE LIM IT APPLIES PER:
<br />POLICY JEC Fxl LOD
<br />OTHER:
<br />GENERAL AGGREGATE
<br />53,000,000
<br />PRODUCTS- COMPIOPAG_G
<br />$3.000,000
<br />S
<br />A
<br />AUTOMOBILE LIABILITY
<br />OWNED SCHEDULED
<br />Ix ANY AUTO
<br />AUTOS ONLY AUTOS
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />51931429
<br />41112018
<br />41112019
<br />COMBINED SINGLE LIMIT
<br />Ea eWdenl
<br />S 1,OD0,000
<br />BODILY INJURY (Per parson)
<br />S
<br />BODILY INJURY (Per accident)
<br />S
<br />PROPERTY DAMAGE
<br />Per accident
<br />8
<br />_
<br />8
<br />A
<br />x
<br />UMBRELLALIAB
<br />EXCESSLIAS
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />51931429
<br />411/2016
<br />411=18
<br />EACH OCCURRENCE
<br />85,000,000
<br />AGGREGATE
<br />85,900,000
<br />DED I X I RETENTIONS
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIAnILITY
<br />ANYPROPRIETORIPARTHERIEXECUTIVE Y�
<br />OFFICERIMEMBER EXCLUDED?
<br />(Mandatory In NH)
<br />If yes, describe urder
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />WCF10243NOS
<br />4 1112010
<br />4/112019
<br />X I STATUTE I I OERH
<br />-
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />E.L. DISEASE -EA EMPLOYEE
<br />$ 1,D00,000
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />A
<br />Inland Marine
<br />51931429
<br />411/2018
<br />41112019
<br />Leased Eq
<br />00,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schadula, may be attached If more apace Is required)
<br />4-4958 NC- Orange Co. Parks & Rec- Gym Hillsborough, NC 27278
<br />Orange County Government Is included as additional Insured with regards to general liability as stated in the policy language with written contract prior to any
<br />loss.
<br />CERTIFICATE HOLDER UAfVf,tLLA I IV14
<br />Orange County Government
<br />PO Box 8181
<br />Hillsborough NC 27278
<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 />C} 19BU -2U15 A(;OKU LrUKI'UKA I IUIV. All rlgnts reserveO.
<br />ACORD 25 {2016)03) The ACORD name and logo are registered marks of ACORD
<br />
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