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DocuSign Envelope ID:6E4FDE4F-889C-4627-A1 B5-27D33C78A736 <br /> COMMU-9 OP ID:PD <br /> ,a►coR°3 CERTIFICATE OF LIABILITY INSURANCE DATE 1 Y) <br /> 11a201201 2o12o1a <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 CONTACT <br /> Summers Thompson Lowry,Inc. PHONE Patricia I<Durward,CIC,AAI FAx <br /> 100 Europa Drive,Suite 577 _(AfC.No.Ext:919-968-4472 119-9424221 <br /> Chapel Hill,NC 27517 ADDRESS:pat@,stlinsure.com Larry A.Summers <br /> INSURER(S)AFFORDING COVERAGE NAIL! <br /> INSURER A.*Alliance for Non-Profits for <br /> INSURED COmfnUnitieS in Schools INSURER B; <br /> Orange County <br /> Alison Pope wsuRERe: <br /> 210 N Columbia Street INSURER D: <br /> Chapel Hill,NC 27614 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 AWAY 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 /> 3 TR � TYPE OF INSURANCE DD BR POLICYNUMBER hSM �YEFF mtowlYYYYY LIMITS <br /> LTR <br /> A X COMPAERCIAL GENERALLIABILITY EACH OCCURRENCE $ 1,000,00 <br /> CLAIMS-7AADE OCCUR X 201441960 1110912074 1710112015 pREh4 SES Ea occur°rtco $ 500,00 <br /> A X ProfLiab-11$2MiL 201441950 1110912014 11/0912015 MED EXP(Any one person) S 20,00 <br /> A X Sex.Abuse-$111MIL 201441950 1110112014 1110112015 PERSONAL&ADV INJURY $ 1,000,00 <br /> GENL AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,00 <br /> POLICY j T "LOC PRODUCTS-CUW)OPAGG S 2,000,00 <br /> OTHER: S <br /> AUTOMOBILE LIABILITY (Ea ac dent)SINGLE LIIAIT $ 1,000,00 <br /> A ANY AUTO X 201441950 1110112014 1110112015 BODI LY I NJURY(Per person) s <br /> ALLOANED SCHEDULED BODWY I NJURY(Per accident) $ <br /> AUTOS NON--ONNED PROPERTY DAI4iAGE S <br /> X HIREDAUTOS X AUTOS Per accident <br /> $ <br /> UMBRELLA LIAe OCCUR EACH OCCURRENCE $ <br /> EXCESS UAB CLAlh4S-%k0E AGGREGATE $ <br /> DED RETENTIONS $ <br /> WORKERS COMPENSATION PER OTH- <br /> ANO EPAPLOYERS'LIABItJTY STATUTE ER <br /> YIN <br /> ANY PROPRIETORIPARTNERIEXECuT1VE MIA E.L EACH ACCIDENT S <br /> OFRCEM,gF ABER EXCLUDED? <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS b0ow E.L DISEASE-POLICY LlMiT S <br /> DESCRIPTION OF OPERATIONS(LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) <br /> It is understood and agreed that the certificateholder is added as <br /> additional insured under general liability and auto liability as required by NOV 2 1 2014 <br /> contract. <br /> CERTIFICATE HOLDER CANCELLATION <br /> ORANGE1 <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Orange County ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Alisa Cornetto,RN, Risk Mgr <br /> 200 S.Cameron St AUTHORIZED REPRESENTATIVE <br /> Hillsborough,NC 27278 <br /> �4nn� Pr �.CVIPyti rrn�S <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD <br />