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DocuSign Envelope ID:4135COFEB-153E-4DO3-A57C-485D606OCC1 E <br /> ORANTEN <br /> CERTIFICATE 4F LIABILITY INSURANCE DATE <br /> /08120Y <br /> 0208/202 <br /> 22 <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 919-471-8222 CONTACTA William Cole King,Jr. <br /> Diversified Insurance PHONE 919.471-8222 FAX <br /> Solutions LLC (A/c,No,Ext): I(Arc,No): <br /> P.O. Box 15734 E-MAIL <br /> Durham, INC 27704- ADDRESS; <br /> Ruth Wingo INSURERIS AFFORDING COVERAGE NAIC# <br /> INSURER A:SCOTTSDALE INS. CO. 44318 <br /> INSURED Orange Tennis Club INSURER B: <br /> 3324 Alex Drive <br /> Hillsborough,NC 27278 INSURERC: <br /> INSURER D: <br /> INSURER E: <br /> INSURER F: <br /> COVERAPES QERTIFICATE NUMBER: REVISION NUMBE R- <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 LTR TYPE OF INSURANCE _ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS <br /> A X I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,001 <br /> CLAIMS-MADE OCCUR X �CPS3253349 09114/2021 09/14/2022 DAMAGE TO RENTED $ <br /> MED EXP(An one Person $ S,000 <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> POLICY 7, JET f �LOC PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> THFIR <br /> COMBINED SINGLE LIMIT <br /> AUTOMOBILE LIABILITY I (E�accidemti <br /> ANY AUTO BODILY INJURY Perperson) <br /> I OWNED SCHEDULED <br /> AUTOS ONLY AUTOS BODILY INJURY accid <br /> HIRED NON-OWNEp PROPERTYQAMAGE <br /> AUTOS ONLY AUTOS ONLY Perac n1 � $ <br /> $ <br /> UMBRELLA LIAB I OCCUR <br /> EACH OCCURRENCE <br /> EXCESS UAB CLAIMS-MADE AGGREGATE $ <br /> DED I I RETENTION$ <br /> WORKERS <br /> EMPLO E R I O <br /> EMPLOYERS'LIABILITY I R <br /> H <br /> LIITY Y/N .�7ATSLTI`I_ <br /> AND E <br /> ANY PRpPRIETOR/PARTNER/EXECUTWE I .L,EACH ACCIDENT <br /> OFFICER/MEM ER EXCLUDED? N/A <br /> (Mandatory in NH) El <br /> E.L.DISEASE-EA EMPLOYEE E <br /> If yes,olescribe under <br /> N QF OPERATIONS below -P <br /> i <br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Orange County Government is added an additional insured. <br /> CERTIFICATE HOLDER CANCELLATION <br /> ORANC01 <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Orange Count Government THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> g Y ACCORDANCE WITH THE POLICY PROVISIONS. <br /> P.O.BOX 8181 <br /> Hillsborough, NC 27278 <br /> AUTHORIZED REPRESENT V <br /> Ruth Wingo <br /> ACORD 25(2016/03) ©1988- 015 ACORD CORPOPY <br /> ION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />