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DocuSign Envelope ID: E45930OD-0094-4E66-A944-039543AOE351 <br /> ® CERTIFICATE OF LIABILITY INSURANCE 771 <br /> E(MM11 YYI <br /> ACaR� <br /> 110612018 <br /> THIS CER7IFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND 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 polley(les)must have ADDITIONAL INSURED provisions or be endorsed. <br /> It SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. Astatement on <br /> this certificate does not confer rights to the certificate holder In lieu of such endorsement(sy. <br /> PRODUCER CONTACT Susan Erickson <br /> NAME: <br /> Capital City Insurance Services A ICON c E [919]85D-7D2D A No: (919)861-791D <br /> 5901 Falls of Neuse Road E-MAIL serlcksorl@cc-is.net <br /> ADDRESS: <br /> Suite 202 INSURERIS]AFFORDING COVERAGE NAIL p <br /> Raleigh NC 27609 INSURERA: Hartford Casualty I ns u rance C ompa ny 29424 <br /> INSURED INSURER B: <br /> Susan HatcheII Landsca pe Architecture Pllc INSURERC: <br /> 711 W North St INSORERO: <br /> INSURER E: <br /> Raleigh NC 27603 INSURERF: <br /> COVERAGES CERTIFICATE NUMBER: 17/18 MASTER WC REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDA80VE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO W-NCH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE I INS URANCEAF FOR DED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> ! SR AUDLSUBR POLICYEFF POLICY EXP <br /> LTR TYPEOFINSURANCE SD WVD POLICYNUMBER MMJODIYYYYJ (MMIDDffYYYI LIMITS <br /> COMMERCIAL GENERAi-LIABILITY EACH OCCURRENCE $ <br /> CLAIMS-MADE OCCURRENTED <br /> RE E Ea occurrence S <br /> MEO EXP(Any onePerson) S <br /> PERSONAL&ADV INJURY # <br /> GENL AGGR EGATE LIMIT APPLtES PER: GENERALAGGREGATE $ <br /> POLICY❑JET L.00 PRODUCTS-COMPIOPAGG <br /> OTHER! S <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> Ea accident <br /> ANYAUTO BODILY INJURY(Per parson) s <br /> ❑VMED SCHEDULED BODILY INJURY(Per accldent) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per acoldenl <br /> $ <br /> UMBRELLA LIAR OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED I I RETENTION$ $ <br /> WORKERS COMPENSATION <br /> AND EMPLOYERS UABILiTY PER <br /> ATUTE ER <br /> ANY PROPRIETORIPARTNERIEXECuIIVE YIN E.L.EACH ACCIDENT $ 1,000,D00 <br /> A OFFICERIMEM0EREXCLIJDED7 NIA 22W$CCL3589 121D212D17 12/02/2018 <br /> (Mandatary in NH) E.I..DISEASE-EA EMPLOYEE $ 1.000.000 <br /> If yes,descdbe under 1,D60,000 <br /> DESCRIPTION OF OPERATIONS"law E.L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may he attached!r mare space Is nequlredl <br /> Re:Blackwood Farm Park <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE!ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN <br /> Marabelh Carr,ASLA ACCORDANCE WITH THE POLICY PROVISIONS- <br /> Orange County <br /> AUTHORIZED REPRESENTATIVE <br /> PO BOX a1S1 , <br /> Hillsborough INC 27276 <br /> b 1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD <br />