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DocuSign Envelope ID: D40ODC89-B8BF-484E-8158-24FOOA82920D <br /> DUKEUNI-01 CHATURVEDIRN <br /> ACORO H DATE(MWDM-YYY) <br /> CERTIFICATE OF LIABILITY INSURANCE 7/1012016 <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($),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 NAM£CT Willis Certificate Center <br /> Willis of North Carolina,Inc. PHONE ax <br /> CID 26 Century Blvd arc No Ext:(877)945-73T8 Arc No):(888)467-2378 <br /> P.O.Box 305191 a D <br /> ° RIESS: certificates Wiil1S.COm <br /> Nashville,TN 37230-6191 <br /> INSURER(S)AFFORDING COVERAGE NAiC If <br /> INSURER A:Duke University Risk Management Trust Fund B1512 <br /> INSURED INSURERB:Durham Casualty Company LTD-Bermuda C6616 <br /> Duke University INSURERC: <br /> Attn Chris Borosk) INSURERD: <br /> PO Box 104143 <br /> Durham,NC 27708 INSURER l; <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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTOALLTHE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> ILTRR TYPE OF INSURANCE PO ICY EFF OLICY EXP LIMITS <br /> IN D WV° POLICY NUMBER MMlD MMlD <br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 2,000,00 <br /> DAMAGE TO RENTE15 <br /> CLAIMS-MADE M OCCUR X GL-DURMRA 0110112016 01101/2016 PREMISES EaoWmence $ <br /> M ED EXP(Any one person) S <br /> PERSONAL&ADV INJURY $ 1,000,00 <br /> GENL AGGREGATE LIMIT APPLIESPER: GENERALAGGREGATE $ 2,000,00 <br /> POLICY r]JECT LOG PRODUCTS-COMWOP AGO $ 2,000,40 <br /> OTHER: S <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 2,000,000 i <br /> A X <br /> ANY 1-163 01101/2015 01/0112016 BODILY INJURY(Per person) $ <br /> ALLOANED SCHEDULED BODILY INJURY(Per acddont) S <br /> X AUTOS kX <br /> NON-OWNED PROPERTY DAMAGE S <br /> HIREDAUTOS AUTOS PeraCCideriF <br /> $ <br /> UMBRELLALIAS OCCUR EACHOCCURRENCE S <br /> EXCESS LIMB i CLAIMS-MADE AGGREGATE $ <br /> DED RETENTIONS $ <br /> OTH <br /> WORKERS COMPENSATION <br /> AND EMPLOYERS'LIABILITY YIN <br /> STATUTE ER <br /> ANY PROPRIETORIPARTNERIEXECUTIVE ❑ NIA E.LEACHACCIDENT $ <br /> OFFICERAIEMBER EXCLUDED? <br /> (Mandatory in NH) E-L.DISEASE-EA EMPLOYE $ <br /> If es,descn'be urnder <br /> D SCRIPTIONOFOPERAT(ON5bolvo E.L DISEASE-POLICYLI MIT S <br /> B Professional Liab 16 LP 1025-P 0710112015 0710112016 Occ,.1,000,00OlAgg: 3,000,00 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 1 DI,Additional Remarks Schedule,may be attached H more space is required) <br /> With respects to Policy No.16 LP 1025-P,Named Insured Includes:Duke University Health System. <br /> With respects to the General Liability Insurance Orange County is included as an Additional Insured. <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 /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORED REPRESENTATIVE <br /> Orange County �r <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br />