2019-533-E DEAPR - Miracle Recreation Equipment Company Efland slide

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DocuSign Envelope ID:Al02013E-8A93-4147-8909-71 F057AA3A2A ® DATE(MM/D CERTIFICATE OF LIABILITY INSURANCE 019 AC'�I2a 01/25/2019 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 endorsement(s). PRODUCER CONTACT 'W8 NAME: Aon Risk Services Central, Inc. PHONE (866) 283-7122 FAX (800) 363-0105 LAC St. Louis MO Office (A/C.No.Ext): (A/C.No.): 4220 Duncan Avenue E-MAIL p Suite 401 ADDRESS: _ St Louis MO 63110 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA: Allied World National Assurance Company 10690 Plavpower HOldinas, Inc. INSURER B: Everest National Insurance Co 10120 11515 vanstory Drive Suite 100 INSURERC: James River Insurance Company 12203 HUNTERSVILLE INC 28078 - 6417 USA INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570074933698 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. Limits shown are as requested INSR TYPE OF INSURANCE ADD SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD MM/DD/YYYY MM/DD/YYYY B X COMMERCIAL GENERAL LIABILITY RC GL 5 1 1 1 110/01/2019 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X❑OCCUR SIR applies per policy terns & conditions DAMAGE TO RENTED $300,000 PREMISES Ea occurrence MED EXP(Any one person) PERSONAL&ADV INJURY $1,000,000 p°Dj GEMLAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $4,000,000 M POLICY X❑PE ❑X LOC PRODUCTS-COMP/OP AGG $4,OOO,OOO CT OTHER: SIR $500,000 CD AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT LO Ea accident ANYAUTO BODILY INJURY(Per person) Z OWNED SCHEDULED BODILY INJURY(Per accident) y AUTOS ONLY AUTOS RED AUTOS NON-OWNED PROPERTY DAMAGE HI ONLY AUTOS ONLY Per accident G1 A X UMBRELLA LIAB X CLAIMS-MADE OCCUR 03115344 10/01/2018 10/01/2019 EACH OCCURRENCE $5,000,000 L) EXCESS LIAB Umbrella AGGREGATE $5,000,000 DED I X RETENTION$10,000 WORKERS COMPENSATION AND PER OTH- EMPLOYERS'LIABILITY Y/N STATUTE I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: Quote # R0100194064 for parts to Repair/Replace Equipment at Central Recreation Park and Fairview Park, Quote # R0100194064 attached for reference. Y�J CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Orange County Parks Division AUTHORIZED REPRESENTATIVE Attn: Sharon Kelly 6823 Millhouse Road e} Chapel Hill NC 28516 USA cY,�'�!a �GIDfG fs e/ ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD