B09_Balsam_Mtn_Campground_site_2_sealed_soils_report_0001.pdf

SITE 2

BALSAM MOUNTAIN CAMPGROUND

GREAT SMOKY MOUNTAIN NATIONAL PARK

SWAIN COUNTY, NC

Contact: Joe Ferowich

Email: John_Ferowich@nps.gov

Henderson NC Seal

Henderson Walker

10/04/2021

LN Davis Insurance Agency 143 N. Main Street P.O. Box 630 Waynesville NC 28786-0630

(828)452-2876

Cincinnati Specialty Underwriters Auto-Owners Insurance Co.

Cincinnati Specialty Underwriters Cincinnati Indemnity Ins. Co.

LAND RESOURCE MANAGEMENT, PLLC

PO Box 9251 Asheville NC 28815-

18988 23280

Gary Lance glance@lndavis.com

1 0

(828)456-5325

X X

X

CSU 0041739A 10/01/202110/01/2022 1,000,000

100,000

5,000 1,000,000 2,000,000 2,000,000

X

X X X

5252434900B 10/01/202110/01/2022 1,000,000

Hired/Non-Owned Auto 1,000,000

N

EWC 0277760D 10/01/202110/01/2022 X

1,000,000 1,000,000 1,000,000

Professional Liability CSU 0041743C 10/01/202110/01/2022 Ea. Occurrence 1,000,000 Aggregate Limit 1,000,000

Soil Scientist specializing in septic tank site consulting.

Certificate Holder is listed as Additional Insured as required by contract.

AI 110833

INSURED COPY

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

INSR ADDL SUBR

LTR INSD WVD

DATE (MM/DD/YYYY)

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 EXP

TYPE 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 RENTED

CLAIMS-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 AGG $JECT

OTHER: $

COMBINED SINGLE LIMIT $

(Ea accident)

BODILY INJURY (Per person) $ANY AUTO

ALL OWNED SCHEDULED BODILY INJURY (Per accident) $

AUTOS AUTOS

HIRED AUTOS

NON-OWNED PROPERTY DAMAGE $

AUTOS (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 LIMIT $DESCRIPTION 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 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

© 1988-2014 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORDACORD 25 (2014/01)

CERTIFICATE OF LIABILITY INSURANCE