2019-016-E DEAPR - Eastern Turf - Cedar Grove Park maintenance

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DocuSign Envelope ID: E7142D2A-ECCC-4A8A-9358-6F13D428AC6D A`� ® CERTIFICATE OF LIABILITY INSURANCE DATE;MMID]IYYYY] 0 01/07/2019 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 endorsemenosy. PRODUCER CONTACT Patty Miller NAME: Business Insurers of Carolinas PHONE NE Ext: (919J 968-4611 FAX No: (919)968-8991 (Ak800 Eastowne Drive,Sulte 208 E-MAIL ADDRESS: p mlller@?business insurers.com PO BOX 2536 INSURER(S)AFFORDING COVERAGE NAIC 0 Chapel Hill NC 27515-2536 INSURER A: Penn National Securtty 32441 INSURED INSURER B: PA National Mutual Gas Inc 14990 Eastern Turf Maintenance Inc. INSURERC: Accident Fund National Ins Go 12305 3305 Anvil Place INSURER D: INSURER E: Raleigh NC 27603 INSURERF: COVERAGES CERTIFICATE NUMBER: 18-19 REVISION NUMBER: THIS IS TO CERTIFYTHATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE 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 I NSURANC E AF FORD E D BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUS1 ONS AN Q CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE 6E INSURANCE POLICY EFE POLL E P LIMITS LTR INSD WVD POLICYNOMBER MMIDDIYYYY MMIODIYYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000 DAMAGE TO RENTED CLAIMS-MADE [9 OCCUR PREMISES Ea occurrence s 1QD,000 MED EXP(Amy One person) 5 5,000 A Y CX9 0727704 03/1512018 03/15/2019 PERSONAL&AOV INJURY g 1.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GEN ERAL AGGREGATE $ 2.000,000 ]C POLICY[g PRC LOC PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER: $ AUTOMOBILEUABILITY CEa aOM9INEDcddentSINGLELIMIT $ 1.000,000 X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED Y AX9 0727704 03/1512018 0311512019 BODILY INJURY(Per accident) S AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY P.'e.rldenl 19 Endorsements S X UMBRELLA LIAR x OCCUR EACH OCCURRENCE $ 3,000,ODO B EXCESS LIAR CLAIMS-MADE UL90727704 03/1512018 03M612019 AGGREGATE $ 3,000,000 DED I~JC RETENTION$ 1 D,Doo $ WORKERS COMPENSATtON OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOWPARTNERIEXECUTIVE ELEAcHACCIDENT $ 1,0DD,DOD G OFFICERIMEMBER EXCLUDED NIA WCV 612420D 03115/2018 03/15/2019 (Mandatory In NH) EL DISEASE-EA EMPLOYEE $ 1,DOD,DDD I I yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below EL,DISEASE-POLICY LIMIT $ Leased/Rented Equipment A CX9 0727704 03/1512018 03/15/2019 60,000ACV $500 deductible DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder is included as additional insured in reference to the General Liability&Auto Liability policies per written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBE11 POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Orange County Parks&Recreation Jonathan Dail ACCORDANCE WITH THE POLICY PROVISIONS. 5800 NC Hwy 86 North AUTHORIZED REPRESENTATIVE Hillsbarough NG 27278 a 198E-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD