2022-142-E-DEAPR-Eastern Turf Maintenance-Soccer field maintenance

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DocuSign Envelope ID: 1AC635AA-EA4F-4955-BBE2-8A60C54AC4F9 DATE(MM/DD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 04/12/2022 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 Patty Miller NAME: Business Insurers of Carolinas aCONN0 Ext: (919)968-4611 /X No: (919)968-8991 800 Eastowne Drive,Suite 208 E-MAIL pmiller@business-insurers.com ADDRESS: PO Box 2536 INSURER(S)AFFORDING COVERAGE NAIC# Chapel Hill NC 27515-2536 INSURERA: Penn National Security 32441 INSURED INSURER B: PA National Mutual Cas Inc Eastern Turf Maintenance Inc. INSURER C: Accident Fund National Ins Co 12305 3618 Corbin Street INSURER D: INSURER E: Raleigh NC 27612 INSURER F: COVERAGES CERTIFICATE NUMBER: CL223734365 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 CLAIMS-MADE F OCCUR PRIM SES Ea :Nru ence $ 100'000 MED EXP(Any one person) $ 5,000 A Y CX9 0727704 03/15/2022 03/15/2023 PERSONAL&ADV INJURY $ 1,000,000 MOTHER LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 JECT: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANYAUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED Y AX9 0727704 03/15/2022 03/15/2023 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accidHent UM/UIM Coverage $ 100,000 X UMBRELLA LIAB M OCCUR EACH OCCURRENCE $ 3,000,000 B EXCESS LAB CLAIMS-MADE UL90727704 03/15/2022 03/15/2023 AGGREGATE $ 3,000,000 X DED RETENTION $ 10,000 Follows GL,AL,WC $ WORKERS COMPENSATION 'NJSTATUTE ER PER H AND EMPLOYERS'LIABILITY Y/N 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ C OFFICER/MEMBER EXCLUDED? NIA Y AF WCP 100014470 01 03/15/2022 03/15/2023 (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 $ A Leased/Rented Equipment CX9 0727704 03/15/2022 03/15/2023 $60,000 ACV Ded$500 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Blanket Additional Insured including Waiver of Subrogation per written contract per attached policy forms in favor of the certificate holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Orange County Dept of Environment Agriculture,Parks&Recreation ACCORDANCE WITH THE POLICY PROVISIONS. 4710 West Ten Road AUTHORIZED REPRESENTATIVE Efland NC 27243 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD