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DocuSign Envelope ID:341CF104-EB06-41CA-A2D2-F25E48FB1B6A <br /> DATE(MMIDDIYYYY) <br /> ,4�aRO� CERTIFICATE OF LIABILITY INSURANCE <br /> 4/16/2019 <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 poiicy(tes) must be endorsed. If SUBROGATION IS WAIVED, subject to <br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER NAVE! Certificate Department <br /> Cavignac&Associates PHONE FAIL <br /> 450 B Street, Suite 1800 _(Alc,No :619-744 0574 c No:619-234-8601 <br /> San Diego CA 92101 ADDRes • rertificates@cavignac.com <br /> INSURE S AFFORDING COVERAGE NAICN <br /> _ INSURER A:Valley Forge Insurance Company 20508 <br /> INSURED NV5INCO-01 INSURER B:COntinerltal Insurance Company 35289 <br /> Calyx Engineers and Consultants, Inc. <br /> PO Box 33127 INSURER c:Berkley Insurance Company 32603 <br /> Raleigh, INC.27636 INSURER D:Continental Casualty Co. 20443 <br /> INSURER E:National Fire Ins.Hartford 20478 <br /> INSURER F <br /> COVERAGES CERTIFICATE NUMBER:342204136 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 /> INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER PO DD�YY ff MM QIYYYY LIMITS <br /> LT <br /> A. x COMMERCIAL GENERAL LIABILITY 6057040530 5/1/2019 5I112020 EACH OCCURRENCE $1.000.000 <br /> CLAIMS-MADE I DAMAGE <br /> OCCUR S( aRENTED occurnancel $1.DD0,000 <br /> MED EXP An one rson $15.000 <br /> PERSONAL&ADV INJURY $1.000,000 <br /> GEUL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2.000,000 <br /> X POLICY ff]JJMECT 7 LOC PRODUCTS-GOMPIOPAGG $2,00D,000 <br /> OTHER: Deductible $0 <br /> ❑ AUTOMOBILE LIABILITY 6057040575 5/1/2019 6IM020 COMBINED SINGLE LIMIT $ <br /> Ea accfde 1-900999 <br /> x ANY AUTO BODILY INJURY(Per person) S <br /> ALL OWNED SCHEDULED BODILY INJURY(Peraccidenl) $ <br /> AUTOS AUTOS <br /> NON-OWNED PROPERTY❑AMAGE $ <br /> HIREOAIJTOS AUTOS r <br /> $ <br /> B X UMBRELLA LIAB x OCCUR CUE6076054554 511r2019 5/1/2020 EACH OCCURRENCE S20,000000 <br /> EXCESS LIAS CLAIMS-MADE AGGREGATE $20,000,000 <br /> DE I X RETENTION$(, $ <br /> E WORKERS COMPENSATION VVC6057040561 5/1/2019 511/2020 X PER OTH- <br /> AND EMPLOYERS'LIABILITY Y STATUTE <br /> ANY PROPRIETORIPARTNERIEXECUTIVE ❑ NIA E.L.EACH ACCIDENT $1.000,000 <br /> OFFICERIMEMaER EXCLUDED? <br /> tMandatary In NH) E.L.DISEASE-EA EMPLOYEE 51,000,DW <br /> If yyes,describe under <br /> RESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000 000 <br /> C Pfcfessronal Liability AEC902012003 51112019 511/2020 Each ClaimlAggregate $10MIS20M <br /> A Business Personal Property 6057040530 5I112019 511/2020 Limit $10,125,000 <br /> B LeasedlRented Equip 6057092160 51V2019 511/2020 Llmlt $1D0,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks 5chedute,may be attached if more space Is required) <br /> Re:Blackwood Farm Park.Excess/Umbrella policy follows form over underlying policies:General Liability,Auto Liability&Employers Liability(additional <br /> insured and waiver of subrogation apply).Professional Liability-Claims made form,defense costs included within limit.Property-Special form,replacement <br /> cast. <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 /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Orange County-Natural&Cultural Resources Division <br /> 306 Revere Rd. AUTHORIZED R EPRE 5 E NTATIVE <br /> Hillsborough NC 27278 <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD <br />