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CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 8/24/2023 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 CONSTITUE 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 an endorsement(s). PRODUCER AUTOMATIC DATA PROC INS 1 ADP BLVD ROSELAND, NJ 07068-1728 CONTACT NAME: PHONE (A/C. No. Ext.): (877) 677-0428 FAX (A/C. No. Ext.): (877) 677-0430 E-MAIL ADDRESS: spcbicadp@travelers.com INSURED CIRCLE PARK, LLC 50 HEATHER DR ROSLYN, NY 11576-2211 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : THE CHARTER OAK FIRE INSURANCE COMPANY INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES (Ea Occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN’L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PROJECT LOC PRODUCTS – COMP/OP AGG $ OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ OWNED AUTOS ONLY SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS ONLY NON-OWNED AUTOS ONLY PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS’ LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS BELOW UB-1X068262-23-42 08/01/2023 08/01/2024 X PER STATUTE OTH -ER Y/N N/A E.L. EACH ACCIDENT $100,000 E.L. DISEASE– EA EMPLOYEE $100,000 E.L. DISEASE – POLICY LIMIT $500,000 $ $ $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION ORANGE COUNTY 300 WEST TRYON STREET P.O. BOX 8181 HILLSBOROUGH, NC 27278 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS AUTHORIZED REPRESENTATIVE © 1993-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/3) The Acord name and logo are registered marks of ACORD The Certiﬁcate Holder is Orange County. This Certiﬁcate Holder is an Additional Insured on the Workers Compensation policy per the Additional Insured Automatic Status Endorsement. All Certiﬁcate Holder privileges apply only if required by written agreement between the Certiﬁcate Holder and the insured, and are subject to policy terms and conditions. DocuSign Envelope ID: CAC818ED-DF6E-4D68-940B-D695AFCF3A68