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DocuSign Envelope ID: 716FBOE9-5CE9-44F5-9BAC-48D7E4C96CD6 <br /> CHAPE-6 OP ID, DM <br /> A4CC)M�^ DATE(1411MI)fYYYY) <br /> �, CERTIFICATE ®F LIABILITY INSURANCE 08126/2014 <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 INSURER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: if the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)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 Ileu of such endorsement(s), <br /> PRODUCER coNTACT Debbie Mason <br /> Carolina National Ins Agney PHONE FAX <br /> 1526 E.Franklin St.Suite 102 JAfC, 919-636-3252 Arc No;919-890.0246 <br /> Chapel Hill,NC 27514 E-MAIL debbfe cnia enc com <br /> Debbie Mason ADDRESS: g y <br /> INSURER(S)AFFORDING COVERAGE NAIC ff <br /> INSURER A.AmTrust North America <br /> INSURED Chapel Hill Carrboro Human INSURERS: <br /> 109 N Graham Street,Ste 104 <br /> Chapel Hill,NC 27516 INSURERC; <br /> INSURER D; <br /> ENSURER E; <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED 13ELOW 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 PAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPEOFLNSURANCE UD POLICYEFF POLICYEXP <br /> LTR SD POLICYNUMBER fAWDD MWDD LIMITS <br /> A X COMMERCIALGENERALLIABILIY EACH OCCURRENCE $ 1,000,000 <br /> AMAGE TO CL-ALMS-MADE �OCCUR X NPP1005772 08121/2014 08/2112015 PREMISES(Ea E—ence) $ 100,00 <br /> MED EXP(Any one person) $ 5,000 <br /> PERSONAL.&ADVINJURY $ 1,000,00 <br /> G ENt AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $ 3,000,000 <br /> POLICY 1-1 JERCOT- F—]LOC PRODUCTS-COM Plop AGG $ 300,000 <br /> OTHER $ <br /> AUTOMOBILE LIABILITY EOAaB3reQiSl[�GLE LIMIT $ 1,000,00 <br /> A ANY AUTO NPP1005772 0812112014 08/21/2015 BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per acddent) $ <br /> AUTOS AUTOS <br /> NON-OWNED PROPERTY DAMAGE $ <br /> X HIREDAUTOS X AUTOS Peracc{denR <br /> UMBREtLALIAS OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAR I CLAIMS MADE AGGREGATE S <br /> DED RETENTIONS S <br /> WORKERS COMPENSATION <br /> AND EMPLOYERS'LIABILITY YIN <br /> STATUTE ER <br /> ANY PROPRIETORIPARTNERIEXECUTIVE El N 1 A E.L.EACH ACCIDENT $ <br /> OFFICERRdEMBER EXCLUDED? <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEd$ <br /> if)y'es,desenbe under <br /> DESCR[PT40N OF OPERATIONS beW N E.L.DISEASE-POLICY L1R4ff $ <br /> A Commercial Appllca NPP1005772 08/21/2014 08121/2015 <br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS!VEHICLES (AGGRO 101.Additional Remarks Schedu[a,may be attached If more space Is required) <br /> Nongrofit organization that tutors x--5 students, distribute food to adult <br /> clients, teach technology to adult clients <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 /> Orange County Risk Manager ACCORDANCE WITH THE POLICY PROVISIONS. <br /> PO Box 8181 <br /> Hllisborough,NC 27278 Debbie REPRESENTATIVE <br /> Debbie Mason <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014101) The ACORD name and Iogo are registered marks of ACORD <br />