2019-047-E DEAPR - Miracle Recreation Equipment replace playground equipment

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DocuSign Envelope ID: FE2D5F70-64AE-410D-A6C6-DD13D47242FB CERTIFICATE OF LIABILITY INSURANCE DATE(MMIOQMlYl) 01128/201/3 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL kNSURED provisions or be endorsed.1f SUBROGATiON IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this w certificate does not confer rights to the certificate holder In lieu of such endorsement(s). G CONTACT m a PRODUCER NAME: Aon Risk services Central, Inc. PHONE (866) 283�-7I22 FAX (800) 363-0105 N St. Louis ate Office [A!C•Ne,Exi]: + •No.• Z3 4220 Duncan Avenue En1vL suite 401 ADDRESS: st Louis NO 63110 USA INSURER(S)ATFORn1NG COVERAGE NA1C# INSURED INSURER A: Allied world National assurance company 10690 PlayDower Holdinqs, Inc. INS URERB: Everest National Insurance Co 10120 11SIS Vanstory Drive INSURERC: lames River Insurance Company 12203 suite 100 HUNTERSVILLE Nc 28078 - 6417 USA INSURERD: INSURER E: INSURER r: COVERAGE$ CERTIFICATE NUMBER: 570074949751 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PER100 INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUE❑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. Limits shown are as requested LTR TYPE OF INSURANCE INS WVD POLICY NUMDER MMiDDfYYYY POLICY EN- MMIOD LlMlis B X COMMERCIAL GENERALLIA011.JTY RC GL EACH OCCURRENCE $1,000,000 SIR applies per policy terns & conditions S3002000 CLAIMS-MADE OCCUR PREMISES Ea occurrence ME EXP(Any one Person] PERSONAL&ADV INJURY $1,00o,000 GENERALAGGREGATE $4,000,000 m GENL AGGR ELATE LIMIT APP LIES PER: POLICY �dE O- �LOC PRODUCTS-CGMPICPAGG $4,000,000 OTHER: SIR $500,000 COMBINEb SINGLE LIMIT AUTOMOBILE LIABILITY a accident.. BODILY INJURY(per person] O 2 ANYAUTO OWNEDBOOILY INJURY(Par aoclden)AUTOSONLYHSCHEDULED Al PROPERTY DAMAGE u HIRED AUTOS NON-OWNED ersooldanl V_ ONLY AUTOS ONLY df A % UMi3RELIALIAB X OCCUR 03115344 10/01/2018 3-0/01/2019 EACH OCCURRENCE S5,000,000 U umbrella AGGREGATE SS A01000 EXCESS LIAB CLAIMS-MADE DEb X RETE NTION S10,000 WORKERS COMPENSATION AND I PER UTE OTH- EMPLOYERS'LIABILITY Y I N E.L.EACH ACCIDENT ANY PROPRIETOR I PARTNER EXECUTIVE OFFICERiMEµe@R EXCLUDED? N I A E.L.DISEASE-EA EMPLOYEE (Mandatory In NH) If yyes,dascnbe under E.L.DISEASE-POLICY LIMIT —_ DESGRiPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS FLoCATIONS 1 VEHICLES[ACORD 101,Additlanal Remarks Schedule,may be altachad it more spaco is required] RF: Quote 0 R0100194064 for parts to Repair/Replace Equipment at central Recreation Park and Fairview Park, Quote N R0100194064 attached for reference. �A CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRWED POLICIES BE: CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Orange county AUTHORIZED REPRESENTATIVE r PO BOX 8181 �Iillsboraugh NC 27278 USA pt988-2016 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD