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DocuSign Envelope ID:27BE0809-07F1-4358-A397-1F35DD236252 <br /> �.� CHARL-1 OP ID: LR <br /> .a►coRa CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) <br /> �.� 06/25/2014 <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 INSUREII AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(€es) 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, _Michael W Riggsbee,Jr <br /> Carolina National Ins A ncyy PHONE FAX <br /> 1526 E.Franklin St.S 1D <br /> uite 2 JAJC,No�Ext):919-636-3252 LAIC, ,,:,919-890-0246 <br /> Chapel Hill,NC 27514 AE-MAIL luke cnia com <br /> Michael Rlggsbee,Jr. DDR enc Ess: ., 9 y <br /> INSURER(S)_AFFORDING COVERAGE NAIC# <br /> INSURER A:Philadelphia Insurance Company ;18058 <br /> INSURED Charles House Association INSURER B:iSurity Inc. <br /> 109 Hillcrest Avenue _� -- <br /> Carrboro,NC 27510 INSURER C: <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. NOTIMTHSTANDING 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 /> EXCLUSIONSAND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> — — <br /> INSR TYPE OF INSURANCE _ POLICY NUMBER MM DICDPCfYY (MMIDDfYYYY LIMITS <br /> LTR <br /> GENERAL LIABILITY EACH OCCURRENCE S 1,000,00 <br /> A X COMMERCIAL GENERAL LIABILITY PHPK1008025 i 0511012014 0511012015 PREMISES(Ea cccurrencel 5 100,00 <br /> CLAIMS-MADE OCCUR VIED EXP(Any ore person) S 5,000 <br /> PERSONAL&ADV INJURY S 1,000,000 <br /> j GENERAL AGGREGATE $ 3,000,00 <br /> GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS_-_COMPIOPAGG $ 3,000,000 <br /> �� POLICY L PRO- <br /> �ZCT i� LOG S <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 <br /> {Ea accident} $_ <br /> A ANY AUTO PHPK1008025 0511012014 05/10/2015 BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED ] BODILY INJURY(Per accident) $ <br /> I� AUTOS -- NON OWNED ! PROPERTY DAMAGE �- - <br /> I HIRED AUTOS X AUTOS (PER ACCIDENT! $ <br /> UMBRELLA LIAB OCCUR - EACH OCCURRENCE__ $ <br /> II EXCESS LAB CLAIMS-MADE -AGGREGATE $ <br /> DEC RETENTION S $ <br /> WORKERS COMPENSATION WC STATU- OTH- <br /> AND EMPLOYERS'LIABILITY X TORY.LI MITS ER <br /> OFRCERIMEMBERIEXCLU OED?ECUTIVE NIA WC19056-2613 06/25/2014 06/25/2015 EL EACH ACCIDENT $ 500,00 <br /> YIN <br /> (Mandatory in NH) ❑ j E.L.DISEASE-EA EMPLOYEE $ 500,00 <br /> If yes,describe under <br /> D ESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ 500,00 <br /> A Professional Lia IPHPK1008025 05110/2014 051012015 Ea Inci 1,000,00 <br /> Aggregate 3,000,00 <br /> i <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES {Attach ACORD 101,Additional Remarks Schedule,if more apace is required) <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 /> For Information Only <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> **** *** <br /> AUTHORIZED REPRESENTATIVE <br /> Michael Riggsbee,Jr. <br /> ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> ACID RD 25(2010/05) The ACORD name and logo are registered marks of ACORD <br />