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ORANG-4 OP ID:SA <br /> CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) <br /> 08/21/2014 <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 NAME:ACT Anita Williams CIC CISR <br /> Senn Dunn-High Point <br /> 1400 Eastchester Drive,St 200 HHcc Ne Ext;336-899-2402 a/c Ne;336-841-5319 <br /> High Point,NC 27265 ADDRESS:awilliams @senndunn.com <br /> Small Business Accounts-HP <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A:U•S.Liability Ins.Co. <br /> INSURED Orange County Disability Aware INSURER B: <br /> Dr.Tim Miles <br /> 503 W.Franklin St.Rm 113 INSURER C: <br /> Chapel Hill,NC 27514 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 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 /> ILTR TYPE OF INSURANCE DDL U POLICY NUMBER POLICY/ //YEYYY MMI DYE LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ <br /> COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ <br /> CLAIMS-MADE 0 OCCUR MED EXP(Anyone person) $ <br /> PERSONAL&ADV INJURY $ <br /> GENERAL AGGREGATE $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ <br /> POLICY PRO LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> Ea a.'d.nt $ <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY Per accident $ <br /> AUTOS AUTOS ( ) <br /> HIREDAUTOS 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 /> WORKERS COMPENSATION WC STATU- OTH- <br /> AND EMPLOYERS'LIABILITY Y/N 11 NY LIMIT ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? ❑ N/A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ <br /> A ND01555294 09120/2013 09/20/2014 D80 1,000,00 <br /> EPLI 1,000,00 <br /> L _L DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> PROOFOF <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Proof of coverage only ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD <br />