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.4lco CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) <br /> `.•�� 09/1712013 <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 be endorsed. If SUBROGATION IS WAIVED,subject to <br /> the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the <br /> certificate holder In lieu of such endorsement(s). <br /> PRODUCER CONTACT Kevin Reavis CIC CPIW <br /> OLD NORTH STATE INSURANCE (919 742 3422 <br /> 103 N CHATHAM AVENUE PHONE ) FAX .(919)742-2754 <br /> SILER CITY NC 27344 E-MAIL kreavis@onstis.com <br /> INS R S AFFORDINQ COVERAGE NAIL 0 <br /> INSURER A:iSurity/Carolina Mutual Ins Co <br /> INSURED ItisupEn .Philadelphia Ins Co <br /> Boys and Gins Club of Eastern Piedmont INSURER c;Travelers Ins Co <br /> PO Box 1788 D. <br /> Pittsboro NC 27312- <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE Ate'SUER POLICY EFF POLICY EXP'Y N MBER (M LIMITS <br /> B GENEMLIABIUTM PHPK1020246 5/14/2013 5/14/2014 EACH OCCURRENCE $ 1,000,000 <br /> X DAMAGE TO RENTED <br /> COMMERCIAL GENERAL LIABILITY $ 100,000 <br /> CLAIMS-MADE Fj(]OCCUR MED EXp[Any one ermn $ 5,000 <br /> X Sexual/Phy Abuse& PERSONAL&ADV INJURY $ 1,000,000 <br /> Molestation$1000000 GENERAL AGGREGATE 2,000,000 <br /> GEN-L AGGREGATE LIMIT APPLIES PER: PRODUCTS-C PIOP AGG $ 2,000,000 <br /> POLICY TROT- L Loc Professional Liab $ 1,000,000 <br /> B AUTOMOBILEUABIUTY PHPK1020246 5/1412013 5/14/2014 COMBINEDSINGLELIMIT 1,000,000 <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> AUTOS AUTOS BODILY INJURY(Per accident) $ <br /> X HIRED AUTOS X NO"WNED PROPERTY DAMAGE $ <br /> I <br /> AUTOS (Per ac6dwo $ <br /> UMBRELLA UAS OCCUR EACH OCCURRENCE $ <br /> EXCESS UAB CLAIMS­MADE AGGREGATE $ <br /> A WORKERS COMPENSATION WC19108-2013 7/1512013 7115/2014 UiC STATU- I <br /> I oTH <br /> AND EMPLOYERS'IJANUTY I N PR —.—.-- <br /> ANY PROPRIETOR/PARTNERIEXECUTNE E.L EACH ACCIDENT $ 1,000,000 <br /> OFFICERMEMBER EXCLUDED? MIA <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLO 1,000,000 <br /> If s,describe under 1,000,000 <br /> E.L DISEASE-POLICY LI rr <br /> C Directors&Officers Liab 105919426 04/21/2013 /21/2014 Each Claim 1,000,000 <br /> C Employment Practices Liab 105919426 /21/2013 /21/2014 Each Claim 1,000,000 <br /> Aggregate 2,000,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHNXES(Attooh ACORD 101,AddItt"al Remmks Schedule,H mere Won Is required) <br /> CERTIFICATE HOLDER CANCELLATION A1000382 <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> 9 tY ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 200 S Cameron Street <br /> Hillsboro NC 27278- AUTHORIZED REPRESENTAIM <br /> ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010 105) The ACORD name and logo are registered marks of ACORD <br />