2015-301-E DSS - LIFE Skills Foundation for fostering youth opportunities $17,000

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DocuSign Envelope ID:8C992E8F-344C-4404-AO07-436 FO BCD 1197 Client#: 1232534 20LIFESKI DATE(MhA)DDlYYYYJ ACORD,,, CERTIFICATE OF LIABILITY INSURANCE 6/09/2015 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(lies)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 NAME IT Beth Wilkerson BB&T Insurance Services,Inc. PHONE Ext i 919 281141500 281141500 (AIC,No)_ 888746$761 A7C,No � _ Post Office Box 13947 ADDRESS: bc_w_ i_lkerson @bbandt.com Durham, INC 27709 INSURERS)AFFORDING COVERAGE NAIC# 919 281-4500 INSURER A:Philadelphia Indemnity Insuranc 18058 INSURED INSURER 8:Accident Fund Ins Co of America 10166 LIFE Skills Foundation INSURER C:Philadelphia Indemnity Insuranc 18058 2670 Durham Chapel Hill Rd INSURER D: Durham,NC 27707-2829 INSURER E 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 CONTRACTOR 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 CONDITfONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE I RL y yBp POLICY NUMBER MMIDIDY EFF MM7UD LIMITS A GENERAL LIABILITY PHPK1221525 1911112014 09/15/201 EACH OCCURRENCE S11,000,000 DAMA RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $1,000,000 CLAIMS-MADE X]OCCUR MED EXP(Any are person) $20,000 PERSONAL&ADV INJURY $7,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG 52,000,000 POLICY IPE LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident S ANY AUTO j BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS AUTOS --- NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS Peraccident UMBRELLA LIAR H OCCUR EACH OCCURRENCE I$ EXCESS LiAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION WCV6075076 3612312014 061231201 X WCSTATU- 0TH-. AND EMPLOYERS'LIABILITY yl YIN ANY PROPRIETOPJPARTNERiEXECUTIVE WCV6075076 6/23/2015 061231201 E.L.EACH ACCIDENT $500,000 OFFICERWEMBER EXCLUDED? � NIA (Mandatory in NH) E.L DISEASE-EA EMPLOYEE $500,000 K yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 A Prof Liability PHPK1221525 9/1512014 09/1512015 1,000,000 Occ 2,000,000 Agg DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,it more space is required) 'Workers Comp Information** Other States Coverage Prop rietorslPartnerslExecutive Officers/Members Excluded: Tim Brooks Tom Reid,Chairman of the Board CERTIFICATE HOLDER CANCELLATION Evidence of Coverage SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1 88-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 7 The ACORD name and logo are registered marks of ACORD #S142846111M13754796 BG3