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DocuSign Envelope ID:77ADDCE7-37BO-477F-A416-OC80FDF64CA2 <br /> DocuSign Envelope ID.79821BOE-AFAB-41355-8DIIC-1393131ICD361 <br /> ��^'�I DATE(MMMDIYYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE 12118,2017 <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(iss)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($). <br /> PRODUCER A Crystal Ireland <br /> NAME; <br /> Business Insurers of Carolinas HONE ext: (919)968-4611 Aid TIo a (919)968-$991 <br /> 800 FastoWne Drive,Suite 208 ADDRESS, cireland@business-insurers.com <br /> PO Box 2536 INSURER($)AFFORDING COVERAGE NAIC N <br /> Chapel Hill NC 27615-2536 INSURERA; Travelers Indeminity Company 25658 <br /> INSURED INSURER s: Phoenix Insurance Company 25623 <br /> Summit Design and Engineering Services PLLC INSURER C; Travelers Property Cas Cc of America 36161 <br /> 604 Meadowlands Drive INSURER D <br /> INSURER E <br /> Hillsborough NC 27278 INSURER F <br /> COVERAGES CERTIFICATE NUMBER: CL17121820766 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 /> l SR ADDLINUUMI POL C EFF POLICY EXP <br /> LTR TYPE OF INSURANCE INSD WVo POLICY NUMBER MMID DIYYYY MwD0 LIMITS <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 11 11000.000 <br /> CLAIMS-MADE Fx—]OCCUR PREMISES Ea occoaance S 34O'®�� <br /> MED EXP(Any one person) $ 15,OOU <br /> A Y 6304KOB9149 01101/2018 01101/2019 PERSONAL&ADVINJURY $ 1,000,000 <br /> GEN1 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 <br /> POLICY PRO- Q <br /> LOG PRODUCTS-C(ImploYAGG S 2>000,004 <br /> -- JECT <br /> OTHER Experience Mod Factor 1 g <br /> AUTOMOBILE LIABILITY COMBINED SINGLE MIT $ tG00.000 <br /> Ea accldenl <br /> IX <br /> ANY AUTO BODILY INJURY(For parson) $ <br /> BOWNED SCHEDULED Y 810-2J958216 ' 0410212017 04/02/2018 BODILY INJURY(Per accident} $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY (Pr <br /> accld.t <br /> Experience Mod Factor 2 <br /> X UMBRELLA LIAR ',�[ OCCUR EACH OCCURRENCE 6 6.000.000 <br /> c ECCESSLIAO CLAIMS-MADE CUP41(264429 01/0112018 01/01/2019 AGGREGATE $ 6.000,000 <br /> DEC I X1 RETENTIONS 10,000 $ <br /> WORKERS COMPENSATION x STATUTE ERH <br /> AND EMPLOYERS'LIABILITY <br /> ANY PAOPRIFTOPJPARTNER(EXECUTIVE (Y`�I�N E.L.EACH ACCIDENT $ 11000,000 <br /> �OFFICERIMEMBER EXCLUDED? t�NJ NNk UB4K258355 01f0112018 01l01I2019 <br /> (Mandatory in NH) E.L.DISEASE-FA EMPLOYEE $ 1400,000 <br /> Ilyas,describe under 1,000,000 <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 5 <br /> Excess Policy over GL,AU,WC <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORO lei,Additional Remarks Schedule,may be allnched It more apace Is required) <br /> Phase I ESA-Efland Hrs Soccer Property Orange County 2015-2016 <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE VNLL BE DELIVERED IN <br /> Orange County ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 200 S Cameron Street <br /> AUTHORIZED REPRESENTATIVE � <br /> PO Box 8181 <br /> Hillsborough NC 27278 <br /> 01988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD <br />