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2022-151-E-DEAPR-Americourt Sport Surfaces-Court Renovation
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2022-151-E-DEAPR-Americourt Sport Surfaces-Court Renovation
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Entry Properties
Last modified
4/22/2022 11:04:51 AM
Creation date
4/22/2022 11:04:09 AM
Metadata
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Template:
Contract
Date
4/20/2022
Contract Starting Date
4/20/2022
Contract Ending Date
4/22/2022
Contract Document Type
Contract
Amount
$23,200.00
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DocuSign Envelope ID:573B6D9F-CFFA-4EEO-B636-B96CA48F61EE <br /> 71/21/2022 <br /> E(MM/DDYYY) <br /> A�" CERTIFICATE OF LIABILITY INSURANCE /Y <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: Brittany Sweet <br /> SIA Group, Inc. PHONE FAX <br /> 827 Gum Branch Road A/C No Ext: 910-478-3373 A/C No):910-455-7481 <br /> Jacksonville NC 28540 ADDRESS: certs@siagroup.com <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURERA: Hanover Insurance Company 22292 <br /> INSURED TRVERNA-01 INSURER B: National Trust Insurance Company 20141 <br /> Americourt Sport Surfaces LLC <br /> 6221 Mt Herman Rd INSURERC: FCCI Insurance Company 10178 <br /> Raleigh NC 27617 INSURERD: <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:983388636 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 EFF POLICY EXP LIMITS <br /> LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DDIYYYY <br /> B X COMMERCIAL GENERAL LIABILITY Y Y CPP10004741101 6/1/2021 6/1/2022 EACH OCCURRENCE $1,000,000 <br /> TED <br /> CLAIMS-MADE � OCCUR PREMISES(Ea o DAMAGE TO ccurrence) $100,000 <br /> MED EXP(Any one person) $5,000 <br /> PERSONAL&ADV INJURY $1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 <br /> POLICY jE LOC PRODUCTS-COMP/OP AGG $2,000,000 <br /> OTHER: $ <br /> C AUTOMOBILE LIABILITY Y Y CA 100047412 02 6/1/2021 6/1/2022 COMBINED SINGLE LIMIT $1,000,000 <br /> Ea accident <br /> X ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> X HIRED X NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> C X UMBRELLA LIAB X OCCUR Y Y UMB 100047410 02 6/1/2021 6/1/2022 EACH OCCURRENCE $5,000,000 <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 <br /> DED X RETENTION$In nnn $ <br /> B WORKERS COMPENSATION Y WC0100071349-01 6/1/2021 6/1/2022 X PER OTH- <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE I I ER <br /> ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $1,000,000 <br /> OFFICER/MEMBER EXCLUDED? N/A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 <br /> A Leased/Rented Equipment IH6D260445 6/1/2021 6/1/2022 Per Item $250,000 <br /> Max Limit $500,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Orange County ACCORDANCE WITH THE POLICY PROVISIONS. <br /> PO Box 8181 <br /> 302 W.Tryon Road AUTHORIZED REPRESENTATIVE <br /> Hillsborough NC 27278 <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />
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