2015-419-E Finance - Chapel Hill Training Outreach Project, Inc./KidSCope - 2015-16 Outside Agency Performance Agreement $75,000

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DocuSign Envelope ID: ED2382C9-A179-4082-A143-C434266568CD Client#:929075 20CHAPEHIL3 DATE 1Y ACOR& CERTIFICATE F LIABILITY INSURANCE AV 01130/2015 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(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 CONTACT Beth Wilkerson NAME: BB&T Insurance Services,Inc. PA/C HONE 919 281-4500 11 No; 8887468761 No Ext Post Office Box 13941 ADDRESS; bcwilkerson @bbandt.com Durham,INC 27709 INSURER(S)AFFORDING COVERAGE NAIC# 919 281-4500 INSURERA:Philadelphia Indemnity Insuranc 18058 INSURED INSURER B:Accident Fund Ins Co of America 10166 Chapel Hill Training Outreach 121 Inc INSURER C: 800 Eastowne Dr Ste 105 INSURER D: Chapel Hill,NC 27514 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 CONTRACT OR 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD MM/DD A GENERAL LIABILITY PHPK1130866 D2105120115 0210512016 EACH OCCURRENCE $1000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $1,000,000 CLAIMS-MADE ®OCCUR MED EXP(Any one person) $20 OOO PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $3,000,000 POLICY JEC LOC I I COMBINED SINGLE LIMIT $ A AUTOMOBILE LIABILITY PHPK1130866 2105/2015 02/05/201 Ea accident 1,000,000 IX ANYAUTO BODILY INJURY(Par person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $AUTOS AUTOS HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS A X UMBRELLA LIAB X OCCUR PHUB449068 0210512015 02/05/2016 EACH OCCURRENCE $1.000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $1,000,000 DIED I X RETENTION$10000 $ B WORKERS COMPENSATION WCV6096247 2/17/2014 121171201 X WC TORY LIMJ- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N E.L.EACH ACCIDENT $500 OOO OFFICERIMEMBER EXCLUDED? ® N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500 OOO If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 A Professional Liab PHPK1130866 0210512015 0210512016 1,000,000 Occurrence $3,000,000 Aggregate DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Certificate Holder is included as additional insured,per written contract,as their interest may appear. CERTIFICATE HOLDER CANCELLATION a County Risk Manager SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Oran g tY g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Post Office Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS. Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE @ 11988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S13645325/M13645294 BG3