2019-164-E Planning - Foster Lake Management Lake Orange Herbicide

Browse Search

DocuSign Envelope ID:6ED905AB-BA4C-48EB-89D3-4675BD9DEFA1 Ae,"R�Cv DATE{Mh11DD1YYYY} CERTIFICATE OF LIABILITY INSURANCE F 03/08/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRrdATIVELY OR NEGATIVELY Ak1END. 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. 1141PORTAN7: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)roust 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 endorsement(s). PRODUCER NAME' David Wright 3aker&Associates,Inc A ONE (919)571-0685 AID No: (919)571-0684 A Subsidia of C ital Insurance L rY � � ADDR ADDRESS: 707 N.Woodrow St. IN SUREBIS1 AFFORDING COVERAGE NAIC# Fuquay-Varina NC 27526 INSURER : Central Mutual Insurance Company 20230 INSURED ENSURER B: Erie Insurance Exchange 26271 Foster Lake&Pond Management, Inc. INSURER PO Box 1294 INSURER D INSURER E Gamer NC 27529 1NSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE 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 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. 1NSR ADDLSUBR POLICY E LTR TYPE OF INSURANCE INSD WvD POLICY NUMSER MM;ODIYYY) IMMIDDIYYYYI LIMITS X coMMERCIALGENERALLIABIL.ITY EACH OCCURRENCE $ 1000000 DAMAGE TO RENT EIT- CLAIMS-MADE 17X OCCUR PREMISES a occurrence $ 300000 X Primary&Non-contributory MED EXP{,any one person) $ 10D00 A Y N CLP9579075 03/20/2019 03/20/2020 PERSONAL&ADV INJURY $ 1000000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 20000DO X LUC PRO $ 2000000 POLICY�JECT OTHER Pollution Liabilit $ 1000000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000 Ea accn:ent X ANY AUTO BODILY INJURY(Per person) $ OWNEA AUTOS AUTOS SCHEDULED N N BAP9579074 03/20/2019 53/20f2020 HODILY INJURY(Per accident) $ AUTOS ONLY AUTOS V HIRED V NON-OWNED PROPERTY DAMAGE $ J� AUTOS ONLY /� AUTOS ONLY Per acci t $ X UMBRELLA LIAS OCCUR EACH OCCURRENCE $ 2000000 A PDED XCESS LIAB CLAIMS-MADE N N CXS9579076 0312012019 03/20/2020 AGGREGATE $ 2000000 II RETENTION$ 10000 $ WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY ANY PRO PRIETOR+PARTNER?EXECLITIVE YIN E .EACH ACCIDENT $ 1000000 S OFFICER:AIEAIBER EXCLUDED? 0 .L MIA N Q877000189 03120/2019 03/2012020 (Mandatory in NH) E.L.DISEASE-lA EMPLOYE E $ 10000DO If yes,describe Under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POL€CY LIMIT $ 1000000 Rented/Leased Equipment A N N CLP9579075 0312012019 03/20/2020 500 deductible 25,000 ❑ESCR1P-no N OF OPERATIONS I LOCATIONS I VEHICLES{ACCRD 101.Addit Iona I Remarks Schedule,may be attached if more space iS requiredI ORANGE COUNTY is an additional insured With respect to the General Liability Policy CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Orange County Planning and Inspections Department ACCORDANCE WITH THE POLICY PROVISIONS. Attn Christopher SANDT, csandt@orangecountync.gov Po Box 8181 AUTHORIZED REPRESENTATIVE 131 W Margaret Lane Hillsborough NC 27278 Fax: Email, ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD