2019-292-E DEAPR - Axiom Environmental Blackwood Farm Park

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DocuSign Envelope ID: EFA046A9-1DCB-4ED7-98BA-B96A823B3D45 AXIOM-1 .4CORO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) `—/ 05121/2019 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 endorsements. PRODUCER 919-467-6339 c Acr James T.Bowers Ed Moore&Associates,Inc. PHONE 919-467-6339 FAX 919-467-6434 103-B KilmaYyne Drive A/C,No,EXt: (A/C,No): Cary,NC 27511 E•M I owers a moorelnsurance.com James T.Bowers INSURERS AFFORDING COVERAGE NAIC# INSURER A:State Auto Mutual 25127 1x111'ornDEnvjron REINSURER B:Liberty Mutual Insurance ggnmental,Inc Continental Casual Com anigh� 1C 27603 ve INSURER C: Casualty Company N INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMB R: 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. LTR INSR TYPE OF INSURANCE DDL SUBR POLICY NUMBER POLICY EFF POLICY EXP YYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE �OCCUR PBP2587025 08 03/17/2019 03/17/2020 DAMAGE TISESO RENTED $ 100,000 MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PEST LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: ' A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 IxANY AUTO PBP2587025 08 03/17/2019 03/17/2020 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILYBODILY INJURY Per accident $ AUTOS ONLY X A�O-S ONLDY (P OP tlent AMAGE $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS-MADE PBP2587025 08 03/17/2019 03/17/2020 AGGREGATE $ 2,000,600 DED I I RETENTION$ B WORKERS COMPENSATION X I PER LITE I X OTH- AND EMPLOYERS'LIABILITY STAT ER C535S370922029 03/17/2019 03/17/2020 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N - - - E.L.EACH ACCIDENT $ O(MCaMEM NH EXCLUDED? ❑ 1'000'000Fant YNIA oryn E.L.DISEASE-EA EMPLOYE $ If es,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT C PROFESSIONAL EEH288236387 03/17/2019 03/17/2020 PER CLAIM 1,000,000 LIABILITY AGGREGATE 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION ORANGEI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ATE THEREOF, Orange County, Department of ACCORDANCEION WITH THE POLICY PROVISIONSE WILL BE DELIVERED IN Environment, Agriculture& Parks&Recreation 306A Revere Road AUTHORIZED REPRESENT � Hillsborough,Road 27278 James T.Bowers 7 59GU4� ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD