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ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />INSR ADDL SUBR <br />LTR INSD WVD <br />PRODUCER CONTACT <br />NAME: <br />FAXPHONE <br />(A/C, No):(A/C, No, Ext): <br />E-MAIL <br />ADDRESS: <br />INSURER A : <br />INSURED INSURER B : <br />INSURER C : <br />INSURER D : <br />INSURER E : <br />INSURER F : <br />POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) <br />AUTOMOBILE LIABILITY <br />UMBRELLA LIAB <br />EXCESS LIAB <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />AUTHORIZED REPRESENTATIVE <br />EACH OCCURRENCE $ <br />DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) <br />MED EXP (Any one person)$ <br />PERSONAL & ADV INJURY $ <br />GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ <br />PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT <br />OTHER:$ <br />COMBINED SINGLE LIMIT <br />$(Ea accident) <br />ANY AUTO BODILY INJURY (Per person)$ <br />OWNED SCHEDULED <br />BODILY INJURY (Per accident)$AUTOS ONLY AUTOS <br />HIRED NON-OWNED PROPERTY DAMAGE <br />$AUTOS ONLY AUTOS ONLY (Per accident) <br />$ <br />OCCUR EACH OCCURRENCE <br />CLAIMS-MADE AGGREGATE $ <br />DED RETENTION $ <br />PER OTH- <br />STATUTE ER <br />E.L. EACH ACCIDENT <br />E.L. DISEASE - EA EMPLOYEE $ <br />If yes, describe under <br />E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below <br />INSURER(S) AFFORDING COVERAGE NAIC # <br />COMMERCIAL GENERAL LIABILITY <br />Y / N <br />N / A <br />(Mandatory in NH) <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <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 />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 />COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: <br />CERTIFICATE HOLDER CANCELLATION <br />© 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) <br />CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) <br />$ <br />$ <br />$ <br />$ <br />$ <br />The ACORD name and logo are registered marks of ACORD <br />6/3/2024 <br />(804) 888-7203 (804) 673-9110 <br />14141 <br />CKL Enterprises, Inc. DBA Ranto's Maintenance and <br />Landscape <br />1317 Country Club Drive <br />Durham, NC 27712 <br />31534 <br />A 1,000,000 <br />X X MP108059310 6/30/2023 6/30/2024 100,000 <br />Blanket AI & WOS 5,000 <br />1,000,000 <br />2,000,000 <br />2,000,000 <br />1,000,000A <br />X X CA10407844 6/30/2023 6/30/2024 <br />B <br />X WBRH667022 6/30/2023 6/30/2024 500,000 <br />N 500,000 <br />500,000 <br />A Equipment Floater MP108059310 6/30/2023 Equipment 30,600 <br />Blanket Additional Insured form #CG20331219 Attached when required by written contract and attached Waiver of Subrogation form # CG24531219. Auto <br />Blanket additional Insured & Waiver of subrogation endorsement form # CAHG00170720 attached when required by contract. General Liability coverage is <br />primary and noncontributory per endorsement form# CGHG290413. <br />Orange County, its officers, agents and employees are designated as additional insured as respects to General Liability. <br />Orange County <br />300 West Tryon Street <br />PO Box 8181 <br />Hillsborough, NC 27278 <br />RANTMAI-01 TFANDREW <br />Towne Insurance Agency, LLC <br />4501 Cox Road <br />Glen Allen, VA 23060 <br />Tammy Andrews <br />tandrews@towneinsurance.com <br />Harford Mutual Insurance Company <br />Citizens Insurance Company of America <br />X <br />6/30/2024 <br />X <br />X <br />X <br />X <br />X <br />X X <br />DocuSign Envelope ID: 563DF970-EDBD-4B14-9868-742C5A6A4A69