2020-140-E DEAPR - Eastern Turf Cedar Grove Park

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DocuSign Envelope ID:B424AF26-E7ED-46BA-8104-9EDD2E363EC5 DATE(MMIDDIYYYY) -�►�� CERTIFICATE OF LIABILITY INSURANCE ❑1/31/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND 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(tes)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 Patty Miller NAME: Business Insurers of Carolinas PHONE Ext: (919)068.4611 me No {919}9fi8-8991 Boo Eastowne Drive,Suite 208 E-MAIL s: pmlllert@business-Insurers.00m ADDRE PO Box 2636 1NSURER(S)AFFORDING COVERAGE NAIC A Chapel Hill NC 27515-2536 INSURERA: Penn National Security 32441 INSURED INSURER B: PA National Mutual Gas Inc Eastern Turf Maintenance Inc. INSURERC• Accident Fund National Ins Co 12305 3305 Anvil Place INSURER D: INSURER E: Raleigh NO 27603 INSURER F: COVERAGES CERTIFICATE NUMBER: 19-20 REVISION NUMBER: THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE 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. ! SR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICYNUMBER MMfDD1YYYY MMIDDIYYYY OMITS x COMMERCIAL GENERALLIASILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE Fx-1 occuR PREMISES Ea occurrence $ 100,000 MEb EXP(Any one person) S 5,000 A Y CX9 0727704 03/1512019 03/15/2020 PERSONAL a ADV INJURY $ 1,000,000 GEN'LAGGREGATE UMITAPPUES PER: GENERALAGGREGATE $ 2,000,000 POLICY [9 jEC�r LOC. PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER: $ BI NED SI NGLE LIM I T S 1,000,000 AUTOMOBILE LIABILITY CPM Ea accldenE x ANYAUTO BODILY INJIRY(Per person) S A OWNED SCHEDULED Y AX9 0727704 03/1512019 03/1512020 BODILY I NJIJ RY(Per accident) S AUTOS ONLY AUTOS xHIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY H AUTOS ONLY Per ecclde S rM X UMBRELLA LIAR I OCCUR EACH OCCURRENCE $ 3,000,000 }ti B EXCESS LIAB CLAIMS-MADE UL90727704 0311512019 031IM020 AGGREGATE S 3,000,000 DIED I XI RETENTION$ 10,000 Follows GL,AL,WC $ WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY Y 1 N ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 G OFFICERIMEMDER EXCLUDED? N 1 A WCV 6124200 03I1512019 03/15/2020 (Mandatory in NH) E.LDISEASE-FAEMPLOYEE $ 1,000,000 If yes,descdbe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ A LeasedlRented Equipment CX9 0727704 03115/2019 03/15/2020 $603000ACV Ded$500 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(ACORD 101,Addffioaal Remarks Schedule,may ba attached If more space is required) Certificate holder is included as additional insured In reference to the Genera]Llablik&Auto Liability polIcles per contract. CERTIFICATE HOLDER CANCELLATION 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Orange County Parks&Rec Robert Robbins ACCORDANCE WITH THE POLICY PROVISIONS. 5800 Hwy 86 N AUTHORIZED REPRESENTATIVE r� 1 Cedar Grove NO 27278 r Jf �, Wle— ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD i