2019-419-E DEAPR - Foster Lake and Pond Management Blackwood Farm

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DocuSign Envelope ID: E0721`61`1-BE22-479A-BD75-1B75EF0994D6 DATE IMM?DD?YYYYI A�"Ra® CERTIFICATE OF LIABILITY INSURANCE 0z252019 THIS CERTIFICATE 15 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 endorsement(s). PRODUCER rCNTACT NAME: David Wright Baker&Associates. I nc A"oNE 919 571-0685 AAA No: 919 571-0684 (A Subsidiary of Capital Insurance) A MARLS . 707 N-Woodrow St. INSURERS AFFORDING COVERAGE N=# Fu ua -Varina NC 27526 ENSURERA: Central Mutual Insurance Company 20230 INSURED INSURER B: Erie Insuranoe Exchange 26271 Foster Lake&Pond Management, I nc- INSURER C PC)BcD<1294 INSURER D INSURER E: Garner NC 27529 INSURER 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- INSR TYPE OF INSURANCE AODL SUBR POLICY NUMBER POLCY EFF POLICY LTR LIMEYS X COMMERCIAL GENERAL LUIBILITY EACH OCCURRENCE $ 1000000 DAMAGE TO RENT EIT_ CLAIMS-MADE ®OCCUR PREMISES a occurrence $ 300000 X Primary&Non-contributory MED EXP(Any orra person) $ 10000 A Y N CLP%79075 0320/2019 03020/2020 PERSONAL&ADV INJURY $ 1000000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2000000 POLICY1:1 PRO X LOC PRODUCTS-COMP.+OP AGG $ 2000000 PRO- OTHER: ber Liabil' $ 50.000 AUTOMOBILE LIABILITY COMaccBINEDident SINGLE LIMIT $ 1000000 Ea X ANY AUTO BODILY RNJURY(Per person) $ A AUTOS ONLY AUTOS OWNED SCHEDULED N N BAP9579074 03/20/2019 03/20/2020 BO DI LY INJU RY(Per acc dent) $ X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Peracadent X UMBRELLA LIAS X OCCUR EACH OCCURRENCE $ 2000000 A EXCESS LIAB CLAIMS-MADE N N CXS9579076 03202019 OWM020 AGGREGATE $ 200D000 DIED RETENTION 10000 $ WORKERS CO MPENSATOIN PERX STATUTE ERH AND EMPLOYERS'LIABILITY B b IANY CERr vIEMER EXCLUDED? Y� NIA N Q877000189 03/20/2019 03C20C202fl E.L-EACH ACCIDENT $ 100D000 (Mandatory In INK) E.L.DISEASE-EA EMPLOYEE $ 1000000 It yes,describe under DESCRIPTION OF OPERATIONS be E.L.DISEASE-POLICY LIMn $ 1000000 Rented/Leased Equipment A IN: N CLP9.579075 o312o12o19 o320l2020 500 deductible 25,000 ❑ESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IA CORD 101,Additional Remarks Schedule,may be attached if more space Is requiredI Orange County is an additional insured with respects to the general liability coverage- CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN Orange County ACCORDANCE WITH THE POLICY PROVISIONS- Blackvrvod Farm Park 4215 NC 86 AUTHORIZED REPRESENTATIVE � 4'a-- �-)c Hillsborough NC 27278 . d Fax: Email: ©1988-2015 ACORD CORPORATION. Al rights reserved. ACQRD 25(2016103) The ACORD name and logo are registered marks of ACORD