2019-485-E DEAPR - Fun2Ref referee services

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DocuSign Envelope ID:6B33048D-5D35-447C-A3B9-54E3CB134930 Ac 0 DATE(MM/DD/YYYY)v�o CERTIFICATE OF LIABILITY INSURANCE 07/20/2018 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 NAME:CONTACT Tonya Marsh Dawson The Marsh Dawson Insurance Agency, LLC P,v"c°N o Ext: 919-806-5109 aC "o: 919-806-5310 5410 INC Highway 55 ADDRESS: mdagencyoffice@gmail.com Suite M INSURER(S)AFFORDING COVERAGE NAIC# Durham INC 27713 INSURER A: NATIONWIDE MUTUAL FIRE INS CO 23779 INSURED INSURERB: AMTRUST NORTH AMERICA INC 524210 FUN 2 REF LLC INSURERC: 1105 INFINITY RD INSURERD: DURHAM NC 27712 INSURERE: 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 ADDL SUBD R POLICY EFF POLICY EXP LIMITS LTR IN WVD POLICY NUMBER MM/DD/YYYY MM/DD A X, COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE � PREMISES occurrence $OCCUR ACP GLG02265150455 ETORENTED 10O 000 PREMI � y N 08/16/2018 08/16/2019 MED EXP(Any one person) $ 1,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO JECT ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO EXCLUDED BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE ACP CAF 2265150455 08/16/2018 08/16/2019 AGGREGATE $ 1,000,000 DIED RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER B ANYPROPRIETOR/PARTNER/EXECUTIVE Y/" WWWC3292368 08/30/2018 08/30/2019 E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBEREXCLUDED? N/A (Mandatory in NH) 10134826 E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Orange County named Additional Insured CERTIFICATE HOLDER CANCELLATION ORANGE COUNTY PO BOX 8181 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN HILLSBOROUGH NC 27278 ACCORDANCE WITH THE POLICY PROVISIONS. 919-644-3042 AUTHO IZEFD REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD