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HomeMy WebLinkAbout2024-697-E-Aging Dept-Carolina Parks and Play-Fit Lot Change Order 01 - Site Grade and Level for new Fit LotRevised 01/24 ORANGE COUNTY CHANGE ORDER REQUEST NORTH CAROLINA ______________________________________________________________________________________________________________ Date: 11/8/2024 Project: Seymour Center Fit Lot Change Order No. 01 Department: Department on Aging Department Address: 2551 Homestead Road, Chapel Hill Project: Seymour Center Fit Lot Contractor: Carolina Parks and Play, LLC Contractor Address: P.O. Box 1246, Cary, NC 27512 Effective date of original contract: 10/24/2024 This change order increases decreases the contract time by days. Check here if no impact to contract time . Will this change order impact the date of substantial completion? Yes No. If yes, the amended date of substantial completion is: _______________________________________________________________________________________________________________ Full Description of Change: Grade site location level for concrete pad. Bring in dirt and raise low side 3 foot, compact, slope sides of pad area to existing grade, seed/straw side slopes for erosion, install sidewalk from existing adjacent concrete area to new exercise area. Reason for Change: The selected location for the the fit lot must be on level grade. _______________________________________________________________________________________________________________ Original contract sum: $ 201,338.00 Contract sum prior to this change order: $ 201,338.00 Amount of this change order: $ 11,174.63 Total sum of the contract including this change order: $ 212,512.63 _______________________________________________________________________________________________________________ This change order is executed to amend the contract time or contract sum. It shall not be construed to impact the original contract, project, services, or work in any other manner. All other terms of the Original Contract remain in effect. Approved and executed this 11th day of October, 2024. _______________________________ _____________________________ _____________________________ Contractor Owner Architect (when retained) By:____________________________ By:___________________________ By:___________________________ Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 11/8/2024 VP 11/18/2024 County Manager Revised 01/24 ORANGE COUNTY—INTERNAL USE ONLY ______________________________________________________________________________ Finance Information Vendor Name: Carolina Parks and Play, LLC Vendor Contact Person: Todd McDuffee (Todd@carolinaparksandplay.com) Phone: 919.469.9188 Address: PO box 1246 City Cary State: NC Zip: 27512 Department: Dept. on Aging Amount: 11,174.63 Purpose: Fit Lot Change Order 01 - Site Grade and Level for new Fit Lot Budget Code(s): 30430120-630120-71099 Vendor # 68590 Vendor Status with NCSOS: Current - Active Vendor is a BOCC consultant: Yes No Contract Details Contract Type: New Amendment (Original Contract: 10/15/2024) (Most Recent Amendment 11/8/2024) Effective Date 10/15/2024 End Date 01/31/2025 Notice Date (Notice Purpose ) Award Approved by Board (Agenda Date: ); Made or Administered by Aging Signature Authority - BOCC Express Delegation (Agenda Date: ) - Policy 9.4: Under $5,000; Service Under $90,000; Construction Under $250,000 - Budget Policy Section XV (Capital Improvement Project: ) Bidding Informal Bidding ($30k-$90k); Formal RFP ($90k+); Other (<$30k); Exception(#DHHS Approval) Department Affirmation This agreement is approved as to technical form and content and I as Department Director affirmatively state work on this project has not been initiated prior to execution of the agreement; OR This agreement is approved as to technical form and content. Services related to this agreement have already begun or been completed. Description of the nature of the emergency condition that was addressed: Department Director’s Signature ________________________________________ Date: ________ Information Technologies This agreement has been reviewed and is approved as to information technology content and specifications: Office of the Chief Information Officer___________________________________ Date: ________ Inapplicable because no hardware/software purchases or related services Risk Management This agreement is approved for sufficiency of insurance standards, specifications, and requirements: Office of the Risk Management Officer___________________________________ Date: _________ Financial Services This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: Office of the Chief Financial Officer ____________________________________ Date: _________ Legal Services This agreement is approved as to legal form and sufficiency: Office of the County Attorney __________________________________________Date: ________ Clerk to the Board All Docusign contracts must be copied to the Clerk upon completion: occlerkdocs@orangecountync.gov The following signature block is for hard copies only and is not required for Docusign contracts: Received for record retention: Office of the Clerk to the Board __________________________________________Date:_________ Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 11/8/2024 11/12/2024 11/15/2024 11/18/2024 Revised 01/24 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 Quote #: 10594 Created: 10/25/2024 Modified: 10/25/2024    ____________________________________________________________________________________________________________ Carolina Parks and Play, LLC Cary, NC 27511 919-469-9188•107 A Fountain Brook Circle • • Standard Terms and Conditions Pricing: Prices are firm for 30 days unless otherwise noted. Installation costs, if shown, are for one installation unless otherwise noted. Taxes will be shown separately, if applicable. Any applicable taxes not shown will be applied to the final invoice. Payment terms: Payment terms are as stated above subject to approval by Credit Manager. Payment in full is due within those terms. Pre-payment may be required for orders equaling less than $5000.00. A signed purchase order made out to the business name and address, as listed in the “Invoice Address” section of this quotation, or this signed quotation is required for all orders unless otherwise noted. A 1.5% per month finance charge will be imposed on all past due accounts. Checks should be made payable to and mailed as indicated in the “Invoice Address” section of this quotation. A fee of 2.95% will be added for payments by credit card. Returns: Returns are available on shipments delivered within the last 60 days if the product is in merchantable condition, has never been installed, and has never been stored in an area with little or no protection. A 25% restocking fee will be charged on all returned goods. Customer will be charged freight for both the outbound and inbound shipment. Any credit will be based on the condition of the item(s) upon return. Installation: The site should be clear, level and allow for unrestricted access of trucks and machinery. Customer is responsible for providing a secure location to off-load and store the equipment during the installation process. The customer is responsible for theft or damage of the equipment from the time the equipment is off-loaded until the installation is complete, unless other arrangements are made and noted on the quotation. The customer is responsible for any locally required building permits unless specifically noted otherwise in this proposal. Price includes only what is stated in this quotation. If additional site work or equipment is needed then the price is subject to change. Drainage $11,174.63Project Total $779.63Project Tax 7.50%Tax Rate $10,395.00Subtotal  0Total Wt 1/3 to order, 1/3 upon equipment delivery, balance upon substantial completion Payment Terms: 3-4 weeks AROLead Time:Carolina Parks and Play P.O. Box 1246 Cary, NC, 27512 (919) 469-9188 Invoice Address Orange County Dept. on Aging 2551 Homestead Rd. Chapel Hill, NC 27516 Ship To:Janice Tyler Orange County Dept. on Aging P.O. Box 8181 Hillsborough, NC 27278 Bill To: Janice Tyler (919) 245-4255 jtyler@orangecountync.gov Prepared For:Todd McDuffee (919) 796-7247 todd@carolinaparksandplay.com Prepared By: FitLot Design GradingQuote Name Please make out purchase orders, contracts, and checks to: Product Line Description Quantity Sales Price Wt Subtotal Total Price Sitework Grade site location level for concrete pad. Bring in dirt and raise low side 3 ft, compact, slope sides of pad area to existing grade, seed/straw side slopes for erosion, install sidewalk from existing adjacent concrete area to new exercise area. 1.00 $10,395.00 0 $10,395.00 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 Quote #: 10594 Created: 10/25/2024 Modified: 10/25/2024    ____________________________________________________________________________________________________________ Carolina Parks and Play, LLC Cary, NC 27511 919-469-9188•107 A Fountain Brook Circle • • requirements not specifically detailed in this proposal are to be completed by others. Customer shall be responsible for unknown conditions such as buried utilities (public and private), tree stumps, rock, or any concealed materials that may result in additional labor or material costs. Customer will be billed hourly or per job for any additional costs. Agreement Execution As an authorized agent, I accept the terms and conditions of this proposal for purchase of goods and services. Name (print) ________________________________ Signature ________________________________ Date _____________ Purchase order # _________________ (please provide) Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 ROY COOPER • Governor KODY H. KINSLEY • Secretary JOYCE MASSEY-SMITH • Director Division of Aging NC DEPARTMENT OF HEALTH AND HUMAN SERVICES • DIVISION OF AGING LOCATION: 693 Palmer Drive, Taylor Hall, Raleigh, NC 27603 MAILING ADDRESS: 2101 Mail Service Center, Raleigh, NC 27699-2101 www.ncdhhs.gov • TEL: 919-855-3400 • FAX: 919-733-0443 AN EQUAL OPPORTUNITY / AFFIRMATIVE ACTION EMPLOYER TO: Jenisha Henneghan, AAA Director Central Pines Regional Council FROM: Joyce Massey-Smith, Director DATE: June 27, 2024 RE: ARPA Senior Center Operations code 172-Acquisition Request-Orange County Department on Aging/Seymour Senior Center-Fit Lot Outdoor Fitness Center This letter serves as official notification that your request to use ARPA funds has been approved. This approval to purchase is contingent upon the eligibility requirements and the availability of funds remaining on the current Notice of Grant Award allocation to your region. A revised request will need to be submitted for approval by the Division if additional funding is needed for this project. Please make sure the ARPA expenditures for this project are encumbered by September 30, 2024, and entered into ARMS by October 14, 2024. The Division commends your ongoing efforts to support older adults and their caregivers. DocuSign Envelope ID: 8EB70ED5-570B-4757-B982-5D05BBEFC2DADocusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD PRODUCER CONTACT NAME: FAXPHONE (A/C, No):(A/C, No, Ext): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person)$ OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION $ PER OTH- STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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. 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). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 7/16/2024 35378 Carolina Parks & Play, LLC PO Box 1246 Cary, NC 27512 22357 914 A 1,000,000 MKLV3PBC002948 10/1/2023 10/1/2024 100,000 Excluded 1,000,000 2,000,000 2,000,000 1,000,000B 21UECDG1943 10/1/2023 10/1/2024 2,000,000A MKLV3EUL102980 10/1/2023 10/1/2024 2,000,000 C 21WECAH6HD8 10/1/2023 10/1/2024 1,000,000 N 1,000,000 1,000,000 See attached policy endorsements for Additional Insured, Waiver of Subrogation and cancellation notice. Orange County 300 West Tryon Street, PO Box 8181 27278 CAROPAR-01 MMONICA Alexander Insurance Agency 541 South Orlando Avenue, Suite 206 Maitland, FL 32751 Peter Katauskas pkatauskas@alexfinancial.com Evanston Insurance Company Hartford Accident & Indemnity Hartford Insurance Group X X X X X X X X X X Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. Form IH 03 13 06 11 Page 1 of 1 ©2011,The Hartford Evanston Insurance CompanyTerm: 10/01/2023 to 10/01/2024Insured: Carolina Parks & Play, LLC Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 Evanston Insurance CompanyTerm: 10/01/2023 to 10/01/2024Insured: Carolina Parks & Play, LLC Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 Evanston Insurance CompanyTerm: 10/01/2023 to 10/01/2024Insured: Carolina Parks & Play, LLC Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 Evanston Insurance CompanyTerm: 10/01/2023 to 10/01/2024Insured: Carolina Parks & Play, LLC Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 Evanston Insurance CompanyTerm: 10/01/2023 to 10/01/2024Insured: Carolina Parks & Play, LLC Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 Evanston Insurance CompanyTerm: 10/01/2023 to 10/01/2024Insured: Carolina Parks & Play, LLC Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 Evanston Insurance CompanyTerm: 10/01/2023 to 10/01/2024Insured: Carolina Parks & Play, LLC Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Countersigned by Authorized Representative Form WC 00 03 13 Printed in U.S.A. Process Date:08/22/23 Policy Expiration Date:10/01/24 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT Policy Number:21 WEC AH6HD8 Endorsement Number: Effective Date:10/01/23 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address:Carolina Parks and Play, LLC 107 FOUNTAIN BROOK CIR CARY NC 27511 We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. SCHEDULE Any person or organization for whom you are required by contract or agreement to obtain this waiver from us. Endorsement is not applicable in KY, NH, NJ or for any MO construction risk Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 10/15/2024 Alexander Insurance Agency 541 South Orlando Avenue, Suite 206 Maitland FL 32751 407-629-4825 407-629-5407 info@alexfinancial.com License#: L029632 Evanston Insurance Company 35378 CAROPAR-01 Travelers Casualty Ins Co Amer 19046Carolina Parks & Play, LLC PO Box 1246 Cary NC 27512 Travelers Indemnity Co of Amer 25666 106048240 A MKLV3PBC003428 10/1/2024 10/1/2025 B BA7Y775306 10/1/2024 10/1/2025 A MKLV3EUL103425 10/1/2024 10/1/2025 C UB7Y810638 10/1/2024 10/1/2025 SEE ATTACHED ENDORSEMENTS FOR CARRIER SPECIFIC TERMS, CONDITIONS, STIPULATIONS AND EXCLUSIONS AS RESPECTS ADDITIONAL INSURED, PRIMARY & NON-ONTRIBUTORY,WAIVER OF SUBROGATION, AND CANCELLATION ENDORSEMENTS. Orange County 300 West Tryon Street, PO Box 8181 27278 USA Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 COMMERCIAL AUTO This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM CA T4 20 02 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTO COVERAGE PLUS ENDORSEMENT Page 1 of 3© 2015 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. GENERAL DESCRIPTION OF COVERAGE – This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. BLANKET ADDITIONAL INSURED B. EMPLOYEE HIRED AUTO C. EMPLOYEES AS INSURED D. SUPPLEMENTARY PAYMENTS – INCREASED LIMITS E. TRAILERS – INCREASED LOAD CAPACITY F. HIRED AUTO PHYSICAL DAMAGE G. PHYSICAL DAMAGE – TRANSPORTATION EXPENSES – INCREASED LIMIT A. BLANKET ADDITIONAL INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II – COVERED AUTOS LIABILITY COVERAGE: Any person or organization who is required under a written contract or agreement between you and that person or organization, that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to be named as an addi- tional insured is an "insured" for Covered Autos Liability Coverage, but only for damages to which this insurance applies and only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Section II. B. EMPLOYEE HIRED AUTO 1.The following is added to Paragraph A.1., Who Is An Insured, of SECTION II – COV- ERED AUTOS LIABILITY COVERAGE: An "employee" of yours is an "insured" while operating a covered "auto" hired or rented under a contract or agreement in an "em- ployee's" name, with your permission, while performing duties related to the conduct of your business. 2. The following replaces Paragraph b. in B.5., Other Insurance, of SECTION IV – BUSI- NESS AUTO CONDITIONS: b.For Hired Auto Physical Damage Cover- age, the following are deemed to be cov- ered "autos" you own: (1)Any covered "auto" you lease, hire, rent or borrow; and (2)Any covered "auto" hired or rented by your "employee" under a contract in an "employee's" name, with your permission, while performing duties related to the conduct of your busi- ness. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". C. EMPLOYEES AS INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II – COVERED AUTOS LIABILITY COVERAGE: H. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT – INCREASED LIMIT I. WAIVER OF DEDUCTIBLE – GLASS J. PERSONAL PROPERTY K. AIRBAGS L. AUTO LOAN LEASE GAP M. BLANKET WAIVER OF SUBROGATION Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 COMMERCIAL AUTO CA T4 20 02 15Page 2 of 3 © 2015 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. Any "employee" of yours is an "insured" while us- ing a covered "auto" you don't own, hire or borrow in your business or your personal affairs. D. SUPPLEMENTARY PAYMENTS – INCREASED LIMITS 1.The following replaces Paragraph A.2.a.(2) of SECTION II – COVERED AUTOS LIABILITY COVERAGE: (2)Up to $3,000 for cost of bail bonds (in- cluding bonds for related traffic law viola- tions) required because of an "accident" we cover. We do not have to furnish these bonds. 2.The following replaces Paragraph A.2.a.(4) of SECTION II – COVERED AUTOS LIABILITY COVERAGE: (4)All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day be- cause of time off from work. E. TRAILERS – INCREASED LOAD CAPACITY The following replaces Paragraph C.1. of SEC- TION I – COVERED AUTOS: 1."Trailers" with a load capacity of 3,000 pounds or less designed primarily for travel on public roads. F. HIRED AUTO PHYSICAL DAMAGE The following is added to Paragraph A.4., Cover- age Extensions, of SECTION III – PHYSICAL DAMAGE COVERAGE: Hired Auto Physical Damage Coverage If hired "autos" are covered "autos" for Covered Autos Liability Coverage but not covered "autos" for Physical Damage Coverage, and this policy also provides Physical Damage Coverage for an owned "auto", then the Physical Damage Cover- age is extended to "autos" that you hire, rent or borrow subject to the following: (1)The most we will pay for "loss" to any one "auto" that you hire, rent or borrow is the lesser of: (a)$50,000; (b)The actual cash value of the damaged or stolen property as of the time of the "loss"; or (c)The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality. (2)An adjustment for depreciation and physical condition will be made in determining actual cash value in the event of a total "loss". (3)If a repair or replacement results in better than like kind or quality, we will not pay for the amount of betterment. (4)A deductible equal to the highest Physical Damage deductible applicable to any owned covered "auto". (5)This Coverage Extension does not apply to: (a)Any "auto" that is hired, rented or bor- rowed with a driver; or (b)Any "auto" that is hired, rented or bor- rowed from your "employee". G. PHYSICAL DAMAGE – TRANSPORTATION EXPENSES – INCREASED LIMIT The following replaces the first sentence in Para- graph A.4.a., Transportation Expenses, of SECTION III – PHYSICAL DAMAGE COVER- AGE: We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense in- curred by you because of the total theft of a cov- ered "auto" of the private passenger type. H. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT – INCREASED LIMIT Paragraph C.1.b. of SECTION III – PHYSICAL DAMAGE COVERAGE is deleted. I. WAIVER OF DEDUCTIBLE – GLASS The following is added to Paragraph D., Deducti- ble, of SECTION III – PHYSICAL DAMAGE COVERAGE: No deductible for a covered "auto" will apply to glass damage if the glass is repaired rather than replaced. J. PERSONAL PROPERTY The following is added to Paragraph A.4., Cover- age Extensions, of SECTION III – PHYSICAL DAMAGE COVERAGE: Personal Property Coverage We will pay up to $400 for "loss" to wearing ap- parel and other personal property which is: (1)Owned by an "insured"; and (2)In or on your covered "auto". This coverage only applies in the event of a total theft of your covered "auto". No deductibles apply to Personal Property cover- age. Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 COMMERCIAL AUTO CA T4 20 02 15 © 2015 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 3 of 3 K. AIRBAGS The following is added to Paragraph B.3., Exclu- sions, of SECTION III – PHYSICAL DAMAGE COVERAGE: Exclusion 3.a. does not apply to "loss" to one or more airbags in a covered "auto" you own that in- flate due to a cause other than a cause of "loss" set forth in Paragraphs A.1.b. and A.1.c., but only: a.If that "auto" is a covered "auto" for Compre- hensive Coverage under this policy; b.The airbags are not covered under any war- ranty; and c.The airbags were not intentionally inflated. We will pay up to a maximum of $1,000 for any one "loss". L. AUTO LOAN LEASE GAP The following is added to Paragraph A.4., Cover- age Extensions, of SECTION III – PHYSICAL DAMAGE COVERAGE: Auto Loan Lease Gap Coverage for Private Passenger Type Vehicles In the event of a total "loss" to a covered "auto" of the private passenger type shown in the Schedule or Declarations for which Physical Damage Cov- erage is provided, we will pay any unpaid amount due on the lease or loan for such covered "auto" less the following: (1)The amount paid under the Physical Damage Coverage Section of the policy for that "auto"; and (2)Any: (a)Overdue lease or loan payments at the time of the "loss"; (b)Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; (c)Security deposits not returned by the les- sor; (d)Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease; and (e)Carry-over balances from previous loans or leases. M. BLANKET WAIVER OF SUBROGATION The following replaces Paragraph A.5., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV – BUSINESS AUTO CONDI- TIONS: 5. Transfer Of Rights Of Recovery Against Others To Us We waive any right of recovery we may have against any person or organization to the ex- tent required of you by a written contract exe- cuted prior to any "accident" or "loss", pro- vided that the "accident" or "loss" arises out of the operations contemplated by such con- tract. The waiver applies only to the person or organization designated in such contract. Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED – PRIMARY AND NON-CONTRIBUTORY WITH OTHER INSURANCE © 2016 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 1CA T4 74 02 16 This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM PROVISIONS 1.The following is added to Paragraph A.1.c., Who Is An Insured, of SECTION ll – COVERED AUTOS LIABILITY COVERAGE: This includes any person or organization who you are required under a written contract or agreement between you and that person or organization, that is signed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to name as an additional insured for Covered Autos Liability Coverage, but only for damages to which this insurance applies and only to the extent of that person's or organization's liability for the conduct of another "insured". 2.The following is added to Paragraph B.5., Other Insurance of SECTION IV – BUSINESS AUTO CONDITIONS: Regardless of the provisions of paragraph a. and paragraph d. of this part 5. Other Insurance, this insurance is primary to and non-contributory with applicable other insurance under which an additional insured person or organization is the first named insured when the written contract or agreement between you and that person or organization, that is signed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, requires this insurance to be primary and non-contributory. Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 POLICY NUMBER: ISSUE DATE: CANCELLATION: Number of Days Notice: WHEN WE DO NOT RENEW (Nonrenewal): Number of Days Notice: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION OR NONRENEWAL PROVIDED BY US This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE PROVISIONS A.If we cancel this policy for any legally permitted reason other than nonpayment of premium, and a number of days is shown for Cancellation in the Schedule above, we will mail notice of cancellation at least the number of days shown for Cancellation in such Schedule before the effective date of cancellation. B.If we do not renew this policy for any legally permitted reason other than nonpayment of premium, and a number of days is shown for When We Do Not Renew (Nonrenewal) in the Schedule above, we will mail notice of nonrenewal at least the number of days shown for When We Do Not Renew (Nonrenewal) in such Schedule before the effective date of nonrenewal. IL T3 20 05 19 © 2019 The Travelers Indemnity Company. All rights reserved.Page 1 of 1 30 30 BA-7Y775306-24-42-G 08-30-24 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 ENDORSEMENT WC 00 03 13 (00) - POLICY NUMBER: EMPLOYERS LIABILITY POLICY AND WORKERS COMPENSATION WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 001 ONE TOWER SQUARE HARTFORD CT 06183 UB-7Y810638-24-42-G We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. SCHEDULE DESIGNATED ORGANIZATION: DESIGNATED PERSON: ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. DATE OF ISSUE:PAGEST ASSIGN: OF08-22-24 11 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 Evanston Insurance Company Term: 10/01/2024 to 10/01/2025 Insured: Carolina Parks & Play, LLC Policy Number: MKLV3EUL103425 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 Evanston Insurance Company Term: 10/01/2024 to 10/01/2025 Insured: Carolina Parks & Play, LLC Policy Number: MKLV3EUL103425 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 Evanston Insurance Company Term: 10/01/2024 to 10/01/2025 Insured: Carolina Parks & Play, LLC Policy Number: MKLV3EUL103425 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 Evanston Insurance Company Term: 10/01/2024 to 10/01/2025 Insured: Carolina Parks & Play, LLC Policy Number: MKLV3EUL103425 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 Evanston Insurance Company Term: 10/01/2024 to 10/01/2025 Insured: Carolina Parks & Play, LLC Policy Number: MKLV3PBC003428 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 10 0413 © Insurance Services Office, Inc., 2012 Page 2 of2 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 Evanston Insurance Company Term: 10/01/2024 to 10/01/2025 Insured: Carolina Parks & Play, LLC Policy Number: MKLV3PBC003428 Evanston Insurance Company Term: 10/01/2023 to 10/01/2024 Insured: Carolina Parks & Play, LLC Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 Name OfAdditional Insured Person(s) Or Organization(s} (Vendor} As required by written contract executed by both parties AllProducts prior to loss Your Products Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Evanston Insurance Company Term: 10/01/2024 to 10/01/2025 Insured: Carolina Parks & Play, LLC Policy Number: MKLV3PBC003428 COMMERCIAL GENERAL LIABILITY CG2015 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - VENDORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE A.Section II -Who Is An Insured is amended to include as an additional insured any person(s) or organization(s) (referred to throughout this endorsement as vendor) shown in the Schedule, but only with respect to "bodily injury" or "property damage" arising out of "your products" shown in the Schedule which are distributed or sold in the regular course of the vendor's business. However: 1.The insurance afforded to such vendor only applies to the extent permitted by law; and 2.If coverage provided to the vendor is required by a contract or agreement, the insurance afforded to such vendor will not be broader than that which you are required by the contract or agreement to provide for such vendor. B.With respect to the insurance afforded to these vendors, the following additional exclusions apply: 1.The insurance afforded the vendor does not apply to: a."Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; b.Any express warranty unauthorized by you; c.Any physical or chemical change in the product made intentionally by the vendor; d.Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; CG2015 0413 © Insurance Services Office, Inc., 2012 Page1 of2 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 e. Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; f. Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; g. Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or h. "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (1) The exceptions contained in Sub- paragraphs d. or f.; or (2) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. 2. This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. C. With respect to the insurance afforded to these vendors, the following is added to Section Ill - Limits Of Insurance: If coverage provided to the vendor is required by a contract or agreement, the most we will pay on behalf of the vendor is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 2015 0413 © Insurance Services Office, Inc., 2012 Page2 of2 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 Name OfAdditional Insured Person{s} Or Organization{s} As required by written contract executed by both parties prior to loss Location And Description OfCompleted Operations All locations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Evanston Insurance Company Term: 10/01/2024 to 10/01/2025 Insured: Carolina Parks & Play, LLC Policy Number: MKLV3PBC003428 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE A.Section II -Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". However: 1.The insurance afforded to such additional insured only applies to the extent permitted by law; and 2.If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B.With respect to the insurance afforded to these additional insureds, the following is added to Section Ill -Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1.Required by the contract or agreement; or 2.Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 0413 ©Insurance Services Office, Inc., 2012 Page1 of1 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 111 MARKEL Evanston Insurance Company Term: 10/01/2024 to 10/01/2025 Insured: Carolina Parks & Play, LLC Policy Number: MKLV3PBC003428 COMMERCIAL GENERAL LIABILITY EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Name Of Person Or Organization: Any person(s) or organization(s) with whom the Named Insured agrees, in a written contract executed prior to the "occurrence", to waive rights of recovery Additional Premium: Included The following is added to Condition 8. Transfer Of Rights Of Recovery Against Others To Us under Section IV - Commercial General Liability Conditions: We waive any right of recovery we may have against any person or organization shown in the Schedule of this endorsement. This waiver applies only to the person or organization shown in the Schedule of this endorsement. All other terms and conditions remain unchanged. MEGL 0241-01 0516 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 111 MARKEL Evanston Insurance Company Term: 10/01/2024 to 10/01/2025 Insured: Carolina Parks & Play, LLC Policy Number: MKLV3PBC003428 COMMERCIAL GENERAL LIABILITY POLICY NUMBER: MKLV3PBC002948 EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION BY US AS REQUIRED BY CONTRACT TO ADDITIONAL INSUREDS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Number Of Days: 30 days The following is added to the Cancellation condition: We will provide written Notice of Cancellation to an additional insured stating when, not less than the number of days shown in the Schedule above, cancellation will become effective. This condition only applies if: 1. The policy is cancelled by us; 2. Cancellation is for reasons other than: a. Nonpayment of premium; or b. Non-payment of any deductible reimbursement; 3. You are required by written contract to provide the additional insured with such notice; and 4. You agree to provide us with a list of the applicable additional insureds, including their complete mailing addresses, within 7 days of our request. If notice is mailed, proof of mailing is sufficient proof of such notice. All other terms and conditions remain unchanged. MEGL 1879 07 15 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 Name OfAdditional Insured Person(s) Or Organization(s) As required by written contract signed by both parties and executed prior to commencement of operations. Location(s) OfCovered Operations All locations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Evanston Insurance Company Term: 10/01/2024 to 10/01/2025 Insured: Carolina Parks & Play, LLC Policy Number: MKLV3PBC003428 COMMERCIAL GENERAL LIABILITY CG 2010 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE A.Section II -Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1.Your acts or omissions; or 2.The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1.The insurance afforded to such additional insured only applies to the extent permitted by law; and 2.If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B.With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1.All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2.That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C.With respect to the insurance afforded to these additional insureds, the following is added to Section Ill -Limits OfInsurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1.Required by the contract or agreement; or CG 2010 0413 © Insurance Services Office, Inc., 2012 Page1 of2 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 10 0413 © Insurance Services Office, Inc., 2012 Page 2 of2 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? INSR ADDL SUBRLTR INSD WVD PRODUCER CONTACTNAME: FAXPHONE(A/C, No):(A/C, No, Ext): E-MAILADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATIONAND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT OTHER: $ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION $ PER OTH-STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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. 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). COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 7/16/2024 35378 Carolina Parks & Play, LLC PO Box 1246 Cary, NC 27512 22357 914 A 1,000,000 MKLV3PBC002948 10/1/2023 10/1/2024 100,000 Excluded 1,000,000 2,000,000 2,000,000 1,000,000B 21UECDG1943 10/1/2023 10/1/2024 2,000,000A MKLV3EUL102980 10/1/2023 10/1/2024 2,000,000 C 21WECAH6HD8 10/1/2023 10/1/2024 1,000,000N1,000,000 1,000,000 See attached policy endorsements for Additional Insured, Waiver of Subrogation and cancellation notice. Orange County 300 West Tryon Street, PO Box 8181 27278 CAROPAR-01 MMONICA Alexander Insurance Agency 541 South Orlando Avenue, Suite 206 Maitland, FL 32751 Peter Katauskas pkatauskas@alexfinancial.com Evanston Insurance Company Hartford Accident & Indemnity Hartford Insurance Group X X X X X X X X X X Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 PreviewSHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 10/16/2024 Alexander Insurance Agency 541 South Orlando Avenue,Suite 206 Maitland FL 32751 407-629-4825 407-629-5407 info@alexfinancial.com License#:L029632 Evanston Insurance Company 35378 CAROPAR-01 Travelers Casualty Ins Co Amer 19046CarolinaParks&Play,LLC PO Box 1246 Cary NC 27512 Travelers Indemnity Co of Amer 25666 342166216 A X 1,000,000 X 100,000 Excluded 1,000,000 2,000,000 X MKLV3PBC003428 10/1/2024 10/1/2025 2,000,000 B 1,000,000 X BA7Y775306 10/1/2024 10/1/2025 A X 2,000,000 X MKLV3EUL103425 10/1/2024 10/1/2025 2,000,000 C XUB7Y81063810/1/2024 10/1/2025 1,000,000 1,000,000 1,000,000 SEE ATTACHED ENDORSEMENTS FOR CARRIER SPECIFIC TERMS,CONDITIONS,STIPULATIONS AND EXCLUSIONS AS RESPECTS ADDITIONAL INSURED,PRIMARY &NON-ONTRIBUTORY,WAIVER OF SUBROGATION,AND CANCELLATION ENDORSEMENTS. Orange County 300 West Tryon Street, PO Box 8181 27278 USA Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 PreviewCOMMERCIAL AUTO This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM CA T4 20 02 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTO COVERAGE PLUS ENDORSEMENT Page 1 of 3© 2015 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. GENERAL DESCRIPTION OF COVERAGE – This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. BLANKET ADDITIONAL INSURED B. EMPLOYEE HIRED AUTO C. EMPLOYEES AS INSURED D. SUPPLEMENTARY PAYMENTS – INCREASED LIMITS E. TRAILERS – INCREASED LOAD CAPACITY F. HIRED AUTO PHYSICAL DAMAGE G. PHYSICAL DAMAGE – TRANSPORTATION EXPENSES – INCREASED LIMIT A. BLANKET ADDITIONAL INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II – COVERED AUTOS LIABILITY COVERAGE: Any person or organization who is required under a written contract or agreement between you and that person or organization, that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to be named as an addi- tional insured is an "insured" for Covered Autos Liability Coverage, but only for damages to which this insurance applies and only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Section II. B. EMPLOYEE HIRED AUTO 1.The following is added to Paragraph A.1., Who Is An Insured, of SECTION II – COV- ERED AUTOS LIABILITY COVERAGE: An "employee" of yours is an "insured" while operating a covered "auto" hired or rented under a contract or agreement in an "em- ployee's" name, with your permission, while performing duties related to the conduct of your business. 2. The following replaces Paragraph b. in B.5., Other Insurance, of SECTION IV – BUSI- NESS AUTO CONDITIONS: b.For Hired Auto Physical Damage Cover- age, the following are deemed to be cov- ered "autos" you own: (1)Any covered "auto" you lease, hire, rent or borrow; and (2)Any covered "auto" hired or rented by your "employee" under a contract in an "employee's" name, with your permission, while performing duties related to the conduct of your busi- ness. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". C. EMPLOYEES AS INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II – COVERED AUTOS LIABILITY COVERAGE: H. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT – INCREASED LIMIT I. WAIVER OF DEDUCTIBLE – GLASS J. PERSONAL PROPERTY K. AIRBAGS L. AUTO LOAN LEASE GAP M. BLANKET WAIVER OF SUBROGATION Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 PreviewCOMMERCIAL AUTO CA T4 20 02 15Page 2 of 3 © 2015 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. Any "employee" of yours is an "insured" while us- ing a covered "auto" you don't own, hire or borrow in your business or your personal affairs. D. SUPPLEMENTARY PAYMENTS – INCREASED LIMITS 1.The following replaces Paragraph A.2.a.(2) of SECTION II – COVERED AUTOS LIABILITY COVERAGE: (2)Up to $3,000 for cost of bail bonds (in- cluding bonds for related traffic law viola- tions) required because of an "accident" we cover. We do not have to furnish these bonds. 2.The following replaces Paragraph A.2.a.(4) of SECTION II – COVERED AUTOS LIABILITY COVERAGE: (4)All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day be- cause of time off from work. E. TRAILERS – INCREASED LOAD CAPACITY The following replaces Paragraph C.1. of SEC- TION I – COVERED AUTOS: 1."Trailers" with a load capacity of 3,000 pounds or less designed primarily for travel on public roads. F. HIRED AUTO PHYSICAL DAMAGE The following is added to Paragraph A.4., Cover- age Extensions, of SECTION III – PHYSICAL DAMAGE COVERAGE: Hired Auto Physical Damage Coverage If hired "autos" are covered "autos" for Covered Autos Liability Coverage but not covered "autos" for Physical Damage Coverage, and this policy also provides Physical Damage Coverage for an owned "auto", then the Physical Damage Cover- age is extended to "autos" that you hire, rent or borrow subject to the following: (1)The most we will pay for "loss" to any one "auto" that you hire, rent or borrow is the lesser of: (a)$50,000; (b)The actual cash value of the damaged or stolen property as of the time of the "loss"; or (c)The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality. (2)An adjustment for depreciation and physical condition will be made in determining actual cash value in the event of a total "loss". (3)If a repair or replacement results in better than like kind or quality, we will not pay for the amount of betterment. (4)A deductible equal to the highest Physical Damage deductible applicable to any owned covered "auto". (5)This Coverage Extension does not apply to: (a)Any "auto" that is hired, rented or bor- rowed with a driver; or (b)Any "auto" that is hired, rented or bor- rowed from your "employee". G. PHYSICAL DAMAGE – TRANSPORTATION EXPENSES – INCREASED LIMIT The following replaces the first sentence in Para- graph A.4.a., Transportation Expenses, of SECTION III – PHYSICAL DAMAGE COVER- AGE: We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense in- curred by you because of the total theft of a cov- ered "auto" of the private passenger type. H. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT – INCREASED LIMIT Paragraph C.1.b. of SECTION III – PHYSICAL DAMAGE COVERAGE is deleted. I. WAIVER OF DEDUCTIBLE – GLASS The following is added to Paragraph D., Deducti- ble, of SECTION III – PHYSICAL DAMAGE COVERAGE: No deductible for a covered "auto" will apply to glass damage if the glass is repaired rather than replaced. J. PERSONAL PROPERTY The following is added to Paragraph A.4., Cover- age Extensions, of SECTION III – PHYSICAL DAMAGE COVERAGE: Personal Property Coverage We will pay up to $400 for "loss" to wearing ap- parel and other personal property which is: (1)Owned by an "insured"; and (2)In or on your covered "auto". This coverage only applies in the event of a total theft of your covered "auto". No deductibles apply to Personal Property cover- age. Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 PreviewCOMMERCIAL AUTO CA T4 20 02 15 © 2015 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 3 of 3 K. AIRBAGS The following is added to Paragraph B.3., Exclu- sions, of SECTION III – PHYSICAL DAMAGE COVERAGE: Exclusion 3.a. does not apply to "loss" to one or more airbags in a covered "auto" you own that in- flate due to a cause other than a cause of "loss" set forth in Paragraphs A.1.b. and A.1.c., but only: a.If that "auto" is a covered "auto" for Compre- hensive Coverage under this policy; b.The airbags are not covered under any war- ranty; and c.The airbags were not intentionally inflated. We will pay up to a maximum of $1,000 for any one "loss". L. AUTO LOAN LEASE GAP The following is added to Paragraph A.4., Cover- age Extensions, of SECTION III – PHYSICAL DAMAGE COVERAGE: Auto Loan Lease Gap Coverage for Private Passenger Type Vehicles In the event of a total "loss" to a covered "auto" of the private passenger type shown in the Schedule or Declarations for which Physical Damage Cov- erage is provided, we will pay any unpaid amount due on the lease or loan for such covered "auto" less the following: (1)The amount paid under the Physical Damage Coverage Section of the policy for that "auto"; and (2)Any: (a)Overdue lease or loan payments at the time of the "loss"; (b)Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; (c)Security deposits not returned by the les- sor; (d)Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease; and (e)Carry-over balances from previous loans or leases. M. BLANKET WAIVER OF SUBROGATION The following replaces Paragraph A.5., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV – BUSINESS AUTO CONDI- TIONS: 5. Transfer Of Rights Of Recovery Against Others To Us We waive any right of recovery we may have against any person or organization to the ex- tent required of you by a written contract exe- cuted prior to any "accident" or "loss", pro- vided that the "accident" or "loss" arises out of the operations contemplated by such con- tract. The waiver applies only to the person or organization designated in such contract. Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 PreviewCOMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED – PRIMARY AND NON-CONTRIBUTORY WITH OTHER INSURANCE © 2016 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 1CA T4 74 02 16 This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM PROVISIONS 1.The following is added to Paragraph A.1.c., Who Is An Insured, of SECTION ll – COVERED AUTOS LIABILITY COVERAGE: This includes any person or organization who you are required under a written contract or agreement between you and that person or organization, that is signed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to name as an additional insured for Covered Autos Liability Coverage, but only for damages to which this insurance applies and only to the extent of that person's or organization's liability for the conduct of another "insured". 2.The following is added to Paragraph B.5., Other Insurance of SECTION IV – BUSINESS AUTO CONDITIONS: Regardless of the provisions of paragraph a. and paragraph d. of this part 5. Other Insurance, this insurance is primary to and non-contributory with applicable other insurance under which an additional insured person or organization is the first named insured when the written contract or agreement between you and that person or organization, that is signed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, requires this insurance to be primary and non-contributory. Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 PreviewPOLICY NUMBER: ISSUE DATE: CANCELLATION: Number of Days Notice: WHEN WE DO NOT RENEW (Nonrenewal): Number of Days Notice: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION OR NONRENEWAL PROVIDED BY US This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE PROVISIONS A.If we cancel this policy for any legally permitted reason other than nonpayment of premium, and a number of days is shown for Cancellation in the Schedule above, we will mail notice of cancellation at least the number of days shown for Cancellation in such Schedule before the effective date of cancellation. B.If we do not renew this policy for any legally permitted reason other than nonpayment of premium, and a number of days is shown for When We Do Not Renew (Nonrenewal) in the Schedule above, we will mail notice of nonrenewal at least the number of days shown for When We Do Not Renew (Nonrenewal) in such Schedule before the effective date of nonrenewal. IL T3 20 05 19 © 2019 The Travelers Indemnity Company. All rights reserved.Page 1 of 1 30 30 BA-7Y775306-24-42-G 08-30-24 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 PreviewENDORSEMENT WC 00 03 13 (00) - POLICY NUMBER: EMPLOYERS LIABILITY POLICY AND WORKERS COMPENSATION WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 001 ONE TOWER SQUARE HARTFORD CT 06183 UB-7Y810638-24-42-G We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. SCHEDULE DESIGNATED ORGANIZATION: DESIGNATED PERSON: ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. DATE OF ISSUE:PAGEST ASSIGN: OF08-22-24 11 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 PreviewEvanston Insurance CompanyTerm: 10/01/2024 to 10/01/2025Insured: Carolina Parks & Play, LLCPolicy Number: MKLV3EUL103425 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 PreviewDocusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 PreviewEvanston Insurance CompanyTerm: 10/01/2024 to 10/01/2025Insured: Carolina Parks & Play, LLCPolicy Number: MKLV3EUL103425 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 PreviewEvanston Insurance CompanyTerm: 10/01/2024 to 10/01/2025Insured: Carolina Parks & Play, LLCPolicy Number: MKLV3EUL103425 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 PreviewEvanston Insurance CompanyTerm: 10/01/2024 to 10/01/2025Insured: Carolina Parks & Play, LLCPolicy Number: MKLV3EUL103425 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 PreviewEvanston Insurance Company Term: 10/01/2024 to 10/01/2025 Insured: Carolina Parks & Play, LLC Policy Number: MKLV3PBC003428 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 Preview2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 10 0413 © Insurance Services Office, Inc., 2012 Page 2 of2 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 PreviewEvanston Insurance Company Term: 10/01/2024 to 10/01/2025 Insured: Carolina Parks & Play, LLC Policy Number: MKLV3PBC003428 Evanston Insurance Company Term: 10/01/2023 to 10/01/2024 Insured: Carolina Parks & Play, LLC Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 PreviewName Of Additional Insured Person(s) Or Organization(s} (Vendor} As required by written contract executed by both parties All Products prior to loss Your Products Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Evanston Insurance Company Term: 10/01/2024 to 10/01/2025 Insured: Carolina Parks & Play, LLC Policy Number: MKLV3PBC003428 COMMERCIAL GENERAL LIABILITY CG 20 15 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - VENDORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE A. Section II - Who Is An Insured is amended to include as an additional insured any person(s) or organization(s) (referred to throughout this endorsement as vendor) shown in the Schedule, but only with respect to "bodily injury" or "property damage" arising out of "your products" shown in the Schedule which are distributed or sold in the regular course of the vendor's business. However: 1. The insurance afforded to such vendor only applies to the extent permitted by law; and 2. If coverage provided to the vendor is required by a contract or agreement, the insurance afforded to such vendor will not be broader than that which you are required by the contract or agreement to provide for such vendor. B. With respect to the insurance afforded to these vendors, the following additional exclusions apply: 1. The insurance afforded the vendor does not apply to: a. "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; b. Any express warranty unauthorized by you; c. Any physical or chemical change in the product made intentionally by the vendor; d. Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; CG 20 15 0413 © Insurance Services Office, Inc., 2012 Page 1 of2 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 Previewe. Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; f. Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; g. Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or h. "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (1) The exceptions contained in Sub­ paragraphs d. or f.; or (2) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. 2. This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. C. With respect to the insurance afforded to these vendors, the following is added to Section Ill ­ Limits Of Insurance: If coverage provided to the vendor is required by a contract or agreement, the most we will pay on behalf of the vendor is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 2015 0413 © Insurance Services Office, Inc., 2012 Page2 of2 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 PreviewName Of Additional Insured Person{s} Or Organization{s} As required by written contract executed by both parties prior to loss Location And Description Of Completed Operations All locations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Evanston Insurance Company Term: 10/01/2024 to 10/01/2025 Insured: Carolina Parks & Play, LLC Policy Number: MKLV3PBC003428 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section Ill - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 0413 © Insurance Services Office, Inc., 2012 Page 1 of1 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 Preview111 MARKEL Evanston Insurance Company Term: 10/01/2024 to 10/01/2025 Insured: Carolina Parks & Play, LLC Policy Number: MKLV3PBC003428 COMMERCIAL GENERAL LIABILITY EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Name Of Person Or Organization: Any person(s) or organization(s) with whom the Named Insured agrees, in a written contract executed prior to the "occurrence", to waive rights of recovery Additional Premium: Included The following is added to Condition 8. Transfer Of Rights Of Recovery Against Others To Us under Section IV - Commercial General Liability Conditions: We waive any right of recovery we may have against any person or organization shown in the Schedule of this endorsement. This waiver applies only to the person or organization shown in the Schedule of this endorsement. All other terms and conditions remain unchanged. MEGL 0241-01 0516 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 Preview111 MARKEL Evanston Insurance Company Term: 10/01/2024 to 10/01/2025 Insured: Carolina Parks & Play, LLC Policy Number: MKLV3PBC003428 COMMERCIAL GENERAL LIABILITY POLICY NUMBER: MKLV3PBC002948 EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION BY US AS REQUIRED BY CONTRACT TO ADDITIONAL INSUREDS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Number Of Days: 30 days The following is added to the Cancellation condition: We will provide written Notice of Cancellation to an additional insured stating when, not less than the number of days shown in the Schedule above, cancellation will become effective. This condition only applies if: 1. The policy is cancelled by us; 2. Cancellation is for reasons other than: a. Nonpayment of premium; or b. Non-payment of any deductible reimbursement; 3. You are required by written contract to provide the additional insured with such notice; and 4. You agree to provide us with a list of the applicable additional insureds, including their complete mailing addresses, within 7 days of our request. If notice is mailed, proof of mailing is sufficient proof of such notice. All other terms and conditions remain unchanged. MEGL 1879 07 15 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 PreviewName Of Additional Insured Person(s) Or Organization(s) As required by written contract signed by both parties and executed prior to commencement of operations. Location(s) Of Covered Operations All locations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Evanston Insurance Company Term: 10/01/2024 to 10/01/2025 Insured: Carolina Parks & Play, LLC Policy Number: MKLV3PBC003428 COMMERCIAL GENERAL LIABILITY CG 20 10 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE A. Section II ­ Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Section Ill - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or CG 20 10 0413 © Insurance Services Office, Inc., 2012 Page 1 of2 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425 Preview2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 10 0413 © Insurance Services Office, Inc., 2012 Page 2 of2 Docusign Envelope ID: EE37019D-002A-492E-8979-A3A09A4ED425