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DocuSign Envelope ID: 57FEBA8F-F3CB-4E27-8449-89742020C9FA <br /> Client#: 510480 20YMCATRI <br /> DATE(MM/DDYYYY) <br /> ACORDTM CERTIFICATE OF LIABILITY INSURANCE 7/22/2015 <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 NAME: Debbie Church <br /> BB&T Insurance Services, Inc. PHONE 910-772-3720 FAx 888-746-8761 <br /> A/C,No,Ext: A/Q No <br /> Post Office Box 13941 E-MAIL <br /> ADDRESS: <br /> Durham, INC 27709 INSURER(S)AFFORDING COVERAGE NAIC# <br /> 919 281-4500 INSURER A:Zurich American Insurance Co 16535 <br /> INSURED INSURER B:Pennsylvania Manufacturers Assn 12262 <br /> The YMCA of the Triangle Area Inc INSURER C:American Guarantee& Liability 26247 <br /> 801 Corporate Center Dr Ste 200 <br /> INSURER D <br /> Raleigh, INC 27607 <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 /> LTR TYPE OF INSURANCE NSR WVD POLICY NUMBER MM/DD YYYY MM/DDYYYYY <br /> LIMITS <br /> A GENERAL LIABILITY CP0102621901 04/01/2015 04/01/2016 EACH OCCURRENCE $1 000,000 <br /> X COMMERCIAL GENERAL LIABILITY PREMISESOEa olccur ence $1,000,000 <br /> CLAIMS-MADE l OCCUR MED EXP(Any one person) $5,000 <br /> PERSONAL&ADV INJURY $1,000,000 <br /> GENERAL AGGREGATE $3,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $1,000,000 <br /> POLICY PRO JECT X LOC $ <br /> C AUTOMOBILE LIABILITY CP0102621901 04101/2015 04/01/201 EaaacccdentSINGLELIMIT $1,000,000 <br /> X ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> X HIRED AUTOS X NON-OWNED Pena accident) <br /> $ <br /> AUTOS <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LAB CLAIMS-MADE AGGREGATE $ <br /> DE D RETENTION$ $ <br /> B WORKERS COMPENSATION 201575044990 410112015 04/01/201 X wo srnru- O <br /> AND EMPLOYERS'LIABILITY RTH- <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $500,000 <br /> OFFICER/MEMBER EXCLUDED? ® N/A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> Orange Count Human Services SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> 9 Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Outside Agency Funding ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 200 South Cameron St <br /> PO BOX 8181 AUTHORIZED REPRESENTATIVE <br /> Hillsborough, NC 27278 <br /> ©1 88-2010 ACORD CORPORATION.All rights reserved. <br /> ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD <br /> #S14523218/M14002838 DSCH <br />