2014-490 Finance - Boys & Girls Club of Eastern Piedmont - Outside Agency Performance Agreement $2,000

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ACO CERTIFICATE OF LIABILITY INSURANCE DATE 04/30/2014 ) 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). PRODUCER CONTACT Kevin Reavis CIC CPI)N OLD NORTH STATE INSURANCE PH ONE FAX N.E. (919)742-3422 (919)742-2754 103 N CHATHAM AVENUE E-MAIL......SILER CITY NC 27344 kreayis @onstis.com INSURER(S)AFFORDING COVERAGE NAIC 0 INSURER A:ISurlty/Carolina Mutual Ins Co INSURED INSURER B•Philadelphia Insurance Company Boys and Girls Club of Eastern Piedmont INSURER C:Travelers Insurance Company PO BOX 1788 INSURER Pittsboro NC 27312- INSURER INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS B GENERAL LIABILITY PHPK1162370 105/14/2014 05/14/2015 EACH OCCURRENCE $ 1,000,000 X DAMAGE TO RENTED 100,000 COMMERCIAL GENERAL LIABILITY I FMISES lEa 2C $ CLAIMS-MADE 'X OCCUR MED EXP An one person) $ 5,000 X Sexual/Phy Abuse& PERSONAL&ADV INJURY $ 1,000,000 Molestation$1000000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO- LOC I Professional Liab $ 1,000,000 B AUTOMOBILE LIABILITY PHPK1162370 05/14/2014 05/14/2015 COMBINED SINGLE LIMIT 1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BCDILY INJURY(Per acadent) $ AUTOS NON-OWNED �OPERTY DAMAGE $ X HIREDAUTOS X AUTOS ' UMBRELLA LIAR r-- OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ A WORKERS COMPENSATION WC19108-2013 07/15/2013 07/15/2014 WC STATU- OTH- AND EMPLOYERS'LIABILITY 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE YIN NIA E I..EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory in NH) E L DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 IPTI N OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Directors&Officers Liab 105919426 04/21/2014 04/21/2015 /Each Claim 1,000,000 Employment Practices Liab lEach Claim 1,000,000 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION A1000382 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Orange County ACCORDANCE WITH THE POLICY PROVISIONS. 200 S Cameron Street Hillsboro NC 27278- AUTHORIZED REPRESENTATIVE @ 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD