2022-057-E-DEAPR-Miracle Recreation Equipment Co-Playground Equipment Replacement

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DocuSign Envelope ID:6524A599-FE9C-462D-9194-38DF67BFAF4D DATE(MM/DD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 01/19/2022 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 Ashley Hill NAME: Jake A Parrott Insurance Agency Inc aCONN0 Ext: (252)523-1041 /X No: (252)523-0145 2508 N HERRITAGE STREET E-MAIL adavis@parrottins.com ADDRESS: PO BOX 3547 INSURER(S)AFFORDING COVERAGE NAIC# KINSTON NC 28502 INSURERA: SCOTTSDALE INSURANCE CO INSURED INSURER B: BUILDERS MUTUAL INS CO 10844 PLAYTIME INSTALLERS,DBA:BILL ELLIS INSURERC: 2106 EMERSON RD INSURER D: INSURER E: KINSTON NC 28504 INSURER F: COVERAGES CERTIFICATE NUMBER: UPDATE AS OF 1/14/22 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 INSURANCEADDLSUBR POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO_7CLAIMS-MADE �X OCCUR PREM SES Ea oNcRETE ante $ 100,000 MED EXP(Any one person) $ 5,000 A Y CPS7506357 01/14/2022 01/14/2023 PERSONAL&ADV INJURY $ 1,000,000 GEN-LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 X JECT LOC PRODUCTS-COMPOPAGG $POLICY ❑ PRO 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTO 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 OCCUR EACH OCCURRENCE $ EXCESS LAB HCLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION xi STATUTE ERH AND EMPLOYERS'LIABILITY Y/N 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ B OFFICER/MEMBER EXCLUDED? NIA WCP1045787 05 04/25/2021 04/25/2022 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 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) ORANGE COUNTY IS INCLUDED ADDITIONAL INSURED WITH RESPECT TO GENERAL LIABILITY,VIA WRITTEN CONTRACT IN FORCE WITH THIS REQUIREMENT INCLUDED.BILL ELLIS IS AN EXCLUDED OFFICER IN W/C COVERAGE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ORANGE COUNTY ACCORDANCE WITH THE POLICY PROVISIONS. PO BOX 8181 AUTHORIZED REPRESENTATIVE HILLSBOROUGH NC 27278 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD