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--�- O RANTE N <br /> ACCIRC) 5 i <br /> CERTIFICATE 4F LIABILITY INSURANCE DATE (MM/g0lYYYY)09124,zo119 <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 policy ( ies ) must have ADDITIONAL INSURED provisions or be endorsed . <br /> If SUBROGATION IS WAIVED , subject to the terms and conditions of the policy , certain policies may require an endorsement. A statement on <br /> this certificate does not confer rights to the certificate holder in lieu of such endorsements . <br /> PRODUCER 919471 -8222 CONTACT Wjillam Cole King , Jr. <br /> NA <br /> Diversified Insurance PHONE g19 _471 .8222 FAX <br /> Solutions LLC A/c No , Ext :EwMAI <br /> Aic , No <br /> P . 0 . Box 15734 ADD <br /> Durham , NC 27704- <br /> William Cole King , Jr. INSURERS AFFORDING COVERAGE NAIC # <br /> INSURER A : SCOTTSDALE INS . CO . 44318 <br /> INSURED Orange Tennis Club INSURER 8 : ,. <br /> 3324 Alex Drive <br /> Hillsborough , NC 27278 INSURER C <br /> INSURER D : <br /> INSURER E <br /> INSURER F : <br /> COVERAGES CERTIFICATE MB 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 ADDI. SUBR POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 110002000 <br /> CLAIMS-MADE ] OCCUR X CpS3253349 09/14/2019 09/14/2020 DAMAGE TO RENTED $ <br /> MED EXP (Any oneperson) 51000 <br /> PERSONAL & ADV INJURY $ 12000 , 000 <br /> 2 000 ,000 <br /> GEN' L AGGREGATE LIMIT APPLIES PER: GENERAL Z AGGREGATE $ 1OOO ,000 <br /> POLICY PPO U LOC PRODUCTS - COMP/OP AGG <br /> OTHER : <br /> AUTOMOBILE LIABILITY ( Ea accident )COMBINED SINGLE LIMIT $ <br /> ANY AUTO BODILY INJURY Perperson ) <br /> OWNED SCHEDULED <br /> AUTOS ONLY AUUTOSSW p BODILY INJURY Per accident <br /> AUTOS ONLY AUTOS ONY PROPERTY AMAGE <br /> Per accident <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ _ <br /> DED RETENTION $ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS' LIABILITY a <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE N / A E. L . EACH ACCIDENT $ <br /> OFFICERIMEM%gR EXCLUDED? <br /> ( Mandatory In N ) E. L. DISEASE - EA EMPLOYEE <br /> If yes, describe under <br /> DESCRIPTION F OPERATIONS below E . L . DISEASE - POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101 , Additional Remarks Schedule, may be attached if more space is required) <br /> Orange County Government Is added an addjitonal Insured . <br /> CERTIFICATE HOLDER CANCELLATION <br /> ORANC01 <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Orange County Government ACCORDANCE; WITH THE POLICY PROVISIONS . <br /> P . O . Box 8181 <br /> Hillsborough , NC 27278 AUTHORIZED REPRESENTATIVE <br /> William Cole King, Jr. <br /> ACORD 25 ( 2016/03 ) © 1988 -2015 ACORD CORPOR TIO . All rights reserved . <br /> The ACORD name and logo are registered marks of ACORD <br />