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SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />INSURER(S) AFFORDING COVERAGE <br />INSURER F : <br />INSURER E : <br />INSURER D : <br />INSURER C : <br />INSURER B : <br />INSURER A : <br />NAIC # <br />NAME:CONTACT <br />(A/C, No):FAX <br />E-MAILADDRESS: <br />PRODUCER <br />(A/C, No, Ext):PHONE <br />INSURED <br />REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES <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 endorsement(s). <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 />OTHER: <br />(Per accident) <br />(Ea accident) <br />$ <br />$ <br />N / A <br />SUBR <br />WVD <br />ADDL <br />INSD <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 />$ <br />$ <br />$ <br />$PROPERTY DAMAGE <br />BODILY INJURY (Per accident) <br />BODILY INJURY (Per person) <br />COMBINED SINGLE LIMIT <br />AUTOS ONLY <br />AUTOSAUTOS ONLY NON-OWNED <br />SCHEDULEDOWNED <br />ANY AUTO <br />AUTOMOBILE LIABILITY <br />Y / N <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH) <br />DESCRIPTION OF OPERATIONS below <br />If yes, describe under <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />$ <br />$ <br />$ <br />E.L. DISEASE - POLICY LIMIT <br />E.L. DISEASE - EA EMPLOYEE <br />E.L. EACH ACCIDENT <br />EROTH-STATUTEPER <br />LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />EXCESS LIAB <br />UMBRELLA LIAB $EACH OCCURRENCE <br />$AGGREGATE <br />$ <br />OCCUR <br />CLAIMS-MADE <br />DED RETENTION $ <br />$PRODUCTS - COMP/OP AGG <br />$GENERAL AGGREGATE <br />$PERSONAL & ADV INJURY <br />$MED EXP (Any one person) <br />$EACH OCCURRENCE <br />DAMAGE TO RENTED $PREMISES (Ea occurrence) <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS-MADE OCCUR <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY PRO-JECT LOC <br />CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) <br />CANCELLATION <br />AUTHORIZED REPRESENTATIVE <br />ACORD 25 (2016/03) <br />© 1988-2015 ACORD CORPORATION. All rights reserved. <br />CERTIFICATE HOLDER <br />The ACORD name and logo are registered marks of ACORD <br />HIRED <br />AUTOS ONLY <br />9/3/2021 <br />Marsh &McLennan Agency LLC <br />2301 Sugar Bush Road,Suite 600 <br />Raleigh NC 27612 <br />Katy Salvado <br />919-719-9589 212-607-1131 <br />Katy.Salvado@MarshMMA.com <br />Builders Mutual Insurance Company 10844 <br />ROYALASSOC Selective Insurance Co of the Southeast 39926RoyalwoodAssociates,Inc. <br />P.O.Box 91145 <br />Raleigh NC 27675-1145 <br />1871582713 <br />B X 1,000,000 <br />X 500,000 <br />15,000 <br />1,000,000 <br />3,000,000 <br />X <br />S1931429 4/1/2021 4/1/2022 <br />3,000,000 <br />B 1,000,000 <br />X <br />X <br />X Hired Auto <br />S1931429 4/1/2021 4/1/2022 <br />Hired Physical Damage $75,000 <br />B X X 6,000,000S19314294/1/2021 4/1/2022 <br />6,000,000 <br />X 0 <br />A X <br />N <br />WCP1024396 4/1/2021 4/1/2022 <br />1,000,000 <br />1,000,000 <br />1,000,000 <br />B Inland Marine S1931429 4/1/2021 4/1/2022 Leased/Rented Equip 60,000 <br />4-5784 NC Orange County Parks &Rec Gym <br />Orange County Government is included as additional insured with regards to general liability as stated in the policy language with written contract prior to any <br />loss. <br />Orange County Government <br />PO Box 8181 <br />Hillsborough NC 27278 <br />DocuSign Envelope ID: 272C764D-35CD-4127-B4A1-413A8E4FD80E