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CHARL-1 _ OP ID: LR <br /> ACOROm DATE(IN M 10 D,YYYY) <br /> �.... CERTIFICATE OF LIABILITY INSURANCE Ofi125/2014 <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 <br /> Carolina National Ins Agncy NAME: Michael W Riggsbee,Jr <br /> 1526 E.Franklin St.Suite 102 AIM E11:919-636-3252 FA c,No): 919-8130-0246 <br /> Chapel Hill,NC 27514 E-MAIL <br /> Michael Riggsbee,Jr. <br /> ADDRESS:luke@cniagency.com <br /> INSURERS)AFFORDING COVERAGE NAIC_# <br /> INSURER A:Philadelphia Insurance Company 18058 <br /> INSURED Charles House Association <br /> 109 Hillcrest Avenue INSURER B:iSurity,Inc. <br /> Carrboro, NC 27510 INSURER C: <br /> INSURER D: <br /> INSURER E: <br /> INSURER F: <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 POL CY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO 1A''" THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL --F ':RMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE POLICY EFF POLICY EXP <br /> LTR POLICY NUMBER MM/DDIYYYY MMIDDIYYYY LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> A X COMMERCIAL GENERAL LIABILITY PHPK1008025 05110/2014 05/1012015 PREMISES RENTED occurrence $ 100,000 <br /> CLAIMS-MADE F7x OCCUR MED EXP(Any one perscn) $ 5,00 <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GENERAL AGGREGATE $ 3,000,00 <br /> GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 3,000,00 <br /> POLICY PRO- LOC <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000 OO <br /> Ea accident $ c <br /> A ANY AUTO PHPK1008025 05110/2014 05/10/2015 BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS PER ACCIDENT <br /> $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAR CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ r $ <br /> WORKERS COMPENSATION X I WC STATU- I OTH- <br /> AND EMPLOYERS'LIABILITY T RY LIMIT <br /> B ANY PROPRIETOR/PARTNER/EXECUTIVE <br /> YIN N WC19056-2013 06/2512014 06/2512015 E.L.EACH ACCIDENT $ 500,00 <br /> OFFICER/MEMBER EXCLUDED? N/A <br /> - <br /> (Mandatory inNH) E.L.DISEASE-EAEMPL OYES $ 500,00 <br /> If yes,describe under 500�0 <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ , <br /> A Professional Lia PHPK1008026 05/10/2014 05/1012015 Ea Inc! 1,000,00 <br /> Aggregate 3,000,00 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEI_IVERED IN <br /> For Information Only"" ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> Michael Riggsbee,Jr. <br /> @ 1988-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD <br />