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DocuSign Envelope ID:41539BC9-6CEO-4CCO-8CEF-CA16CC89F944
<br /> BROCCON-01 PRADU1
<br /> ,4coR0` CERTIFICATE OF LIABILITY INSURANCE 7DATE(MMIDD/YYYY)
<br /> 2/22/2022
<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 endorsement(s).
<br /> PRODUCER CONTACT
<br /> NAME:
<br /> First Citizens Insurance Services PHONE FAX
<br /> 8510 Colonnade Center Drive 5th Floor (A/C,No,Ext): (888)322-4678 / ,No):(919)716
<br /> PO Box 29611 (27626-0611) ADDRESS:insurance@firstcitizens.com
<br /> Raleigh,INC 27615
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURER A:Penn National Security Insurance Company 32441
<br /> INSURED INSURER B:
<br /> Brock Contract Services,Inc. INSURER C:
<br /> PO Box 33415 INSURER D:
<br /> Raleigh,NC 27636
<br /> INSURER E
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 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 ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD MM DD YYY MM DD YYY
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X OCCUR CX90770741 4/1/2021 4/1/2022 DAMAGE TO RENTED 500,000
<br /> X PREMISES Ea occurrence $
<br /> X XCU Included MED EXP(Any oneperson) $ 10,000
<br /> X Contractual Liab Inc PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY�X PRO
<br /> POLICY ❑X LOC PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> X OTHER:Contractual Liability EMPLOYEE BENEFI $ 1,000,000
<br /> A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
<br /> Ea accident $
<br /> X ANY AUTO AX90770741 4/1/2021 4/1/2022 BODILY INJURY Perperson) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY Per accident $
<br /> X HIRED X NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY Per accident $
<br /> A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 6,000,000
<br /> EXCESS LIAB CLAIMS-MADE UL90770741 4/1/2021 4/1/2022 AGGREGATE $ 6,000,000
<br /> DED X RETENTION$ 0 $
<br /> A WORKERS COMPENSATION X PER OTH-
<br /> ANDEMPLOYERS'LIABILITY STATUTE ER
<br /> Y/N Wp90770741 4/1/2021 4/1/2022 1,000,000
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $
<br /> OFFICER/MEMBER EXCLUDED?
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> A Transit Coverage CX90770741 4/1/2021 4/1/2022 Deductible$2,500 300,000
<br /> A Leased/Rented Equip CX90770741 4/1/2021 4/1/2022 Deductible$2,500 100,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Re:Orange County Cedar Grove Rec Center.
<br /> Orange County Asset Management Services is included as an Additional Insureds with regards to General Liability as required by written contract prior to a
<br /> loss.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Orange Count Asset Management Services THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> 9 Y g ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 300 West Tryon Street Bldg B 3rd Floor Office 10
<br /> Hillsborough,INC 27278
<br /> AUTHORIZED REPRESENTATIVE
<br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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