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CHAPE-6 OP ID: DM <br /> '4k�� CERTIFICATE OF LIABILITY INSURANCE DATE(MMroD <br /> 08/26/2014 014 <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: Debbie Mason <br /> 1526 E.Franklin St.Suite 102 AIcNNo EM: 919-636-3252 ac No):919-890-0246 <br /> Chapel Hill,NC 27514 E-MAIL <br /> Debbie Mason ADDRESS:debbie@cniagency.com <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A:AmTrust North America <br /> INSURED Chapel Hill Carrboro Human INSURER B: <br /> 109 N Graham Street,Ste 104 <br /> Chapel Hill, NC 27516 INSURERC: <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 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 POLICY EFF POLICY EXP <br /> LTR POLICY NUMBER MM/DD MM/DD/YYYY LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 <br /> -DAMAGE TO RENT <br /> CLAIMS-MADE a OCCUR X NPP1005772 08/21/2014 08/21/2015 PREMISES Ea occurrence $ 100,00 <br /> MED EXP(Any one person) $ 5,00 <br /> PERSONAL&ADV INJURY $ 1,000,00 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,00 <br /> POLICY EI PRO- <br /> JECT LOC PRODUCTS-COMP/OP AGG $ 300,00 <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> Ea a..dantL $ 1,000,00 <br /> A ANY AUTO NPP1005772 08/21/2014 08/21/2015 BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY Per accident $ <br /> AUTOS AUTOS ( ) <br /> NON-OWNED PROPERTY DAMAGE <br /> X HIRED AUTOS X AUTOS Per accident $ <br /> $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAR CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION PER 01H- <br /> AND EMPLOYERS'LIABILITY YIN STATUTE ER <br /> ANY PROPRIETORIPARTNER/EXECUTIVE <br /> OFFICER/MEMBER EXCLUDED? F__]N/A E.L.EACH ACCIDENT $ <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> A Commercial Applica NPP1005772 08/21/2014 08/21/2015 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) <br /> Non-profit organization that tutors K-5 students, distribute food to adult <br /> clients, teach technology to adult clients <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Orange County Risk Manager ACCORDANCE WITH THE POLICY PROVISIONS. <br /> PO Box 8181 <br /> Hillsborough,NC 27278 AUTHORIZED REPRESENTATIVE <br /> Debbie Mason <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br />