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(MMMDIYYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE 610912015 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 [AADDRESS:TACT Beth Wilk erson ME:BB&T Insurance Services, Inc. ONE Eld:919 281-4500 A/C,No): 8887468761 Post Office Box 13941 MAIL _bcwilkerson @bbandt.com Durham,NC 27709 INSURER(S)AFFORDING COVERAGE NAIC# 919 281-4500 INSURERA:Philadelphia Indemnity Insuranc 18058 INSURED INSURER B:Accident Fund Ins Co of America 10166 LIFE Skills Foundation INSURERC: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 CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER POLICY YY MMIUDmYY LIMITS A GENERAL LIABILITY PHPK1221525 0911512014 09115/2015 EACH OCCURRENCE $1,000,000 DAMA,ET RENTED XI COMMERCIAL GENERAL LIABILITY PRFMISES Ea occurrence $1,000,000 CLAIMS-MADE 7XI OCCUR MED EXP(Any one person) 520,040 j I PERSONAL S.ADV INJURY S1,000,000 ! GENERAL AGGREGATE 52,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMMOP AGG s2,000,000 POLICY JE a ,LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIME7 Ea accident)S ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODkLY INJURY(Per accidant) $ AUTOS AUTOS ---- - HlREDAUTOS NAO OSWNED PROPERTY DAMAGE $ Per accident) 1$ UMBRELLA LIAR EACH OCCURRENCE $ occuR EXCESS LIAB CLAIMS_-_MADE AGGREGATE J $ DED RETENTION$ !$ B OTH- WORKERS COMPENSATION WCV6075076 0612312014 061231201 X I WG sTAru- FIR AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN WCV6075076 6/23/2015 061231201 E.L.EACH ACCIDENT $500,000 OFFICERIMEMBER EXCLUDED? � N J A (Mandatary In NH) E.L.DISEASE-EA EMPLOYEE $500 000 If yes,descnba under E.L DESCRIPTION OF OPERATIONS below .DISEASE-POLICY LIMIT 8500,000 A Prof Liability PHPK1221525 911512014',0911512015 1,000,000 Occ 2,000,000 Agg DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if 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 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE a 1 88-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of i The ACORD name and logo are registered marks of ACORD #514284611/M 13754796 13133