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CI ient#:510480 20YMCATRI <br /> ACORD,M CERTIFICATE OF LIABILITY INSURANCE <br /> DATE 25/20D/YYYI� <br /> 7/25/2014 <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(les)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 CONT AMA E: Debbie Church <br /> NAM <br /> BBSrT Insurance Services,Inc. ° a-772 C No, 888-746-8761 ac o Ext:?10 <br /> Post Office Box 13941 AE-MAIL <br /> Durham,INC <br /> C 27709 INSURER(S)AFFORDING COVERAGE NAIC# <br /> 919 281-4500 INSURER A:Granite State Insurance Company 23809 <br /> INSURED The YMCA of the Triangle Area Inc INSURERS:Pennsylvania Manufacturers Asso 12262 <br /> 801 Corporate Center Dr Ste 200 INSURER C: <br /> INSURER D: <br /> Raleigh,NC 27607 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 POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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 ADDL SUBR POLICY EFF POLICY EXP <br /> LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS <br /> • GENERAL LIABILITY 01 LX00398090-11 4/01/2013 08/01/201 EACH OCCURRENCE <br /> $11000000 <br /> X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $100,000 <br /> CLAIMS-MADE �OCCUR MED EXP An one person) $5,000 <br /> PERSONAL&ADV INJURY $1,000,000 <br /> GENERAL AGGREGATE s3,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $1,000,000 <br /> POLICY PRO- LOC $ <br /> • AUTOMOBILE LIABILITY 02LX006437103-10 0410112013 081011201 COMBINED SINGLE LIMIT <br /> Ea accident 1,000,000 <br /> X ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OS SCHEDULED BODILY INJURY Per accident $ <br /> AUTOS AUTOS ( ) <br /> X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS Per accident <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED I I RETENTION$ $ <br /> B WORKERS COMPENSATION 201375 0449900 4/01/2013 08/01/2014X WC STATU- OTH- <br /> AND EMPLOYERS'LIABILITY <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE — E.L.EACH ACCIDENT $500000 <br /> OFFICER/MEMBER EXCLUDED? � N/A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> Orange County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> 200 South Cameron Street ACCORDANCE WITH THE POLICY PROVISIONS. <br /> PO Box 8181 <br /> Hillsborough,NC 27278 AUTHORIZED REPRESENTATIVE <br /> ©1 88-2010 ACORD CORPORATION.All rights reserved. <br /> ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD <br /> #S12736300/M12157327 DSCH <br />