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DocuSign Envelope ID:8B670D51-A7FD-4694-8E94-963553021305 <br /> r COMMEMP OP ID: LH <br /> DATE(MM/DD/YYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE 08/12/2015 <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 /> CONTACT <br /> PRODUCER <br /> Phone: 919-682-4814 NAME: Lee Hammond <br /> The Sorgi Insurance Agency Fax:919-682-4906 PHONE 919-682-4814 FAX No: 919-682-4906 <br /> 16 Consultant Place Suite 102 ,vc No Ext <br /> Durham, NC 27707 A DRESS: lee@sorgiinsurance.com E.Sorgi,CIC <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A:Erie Insurance Exchange 26271 <br /> INSURED Community Empowerment Fund INSURER B: <br /> 108 W. Rosemary St. <br /> Chapel Hill,NC 27516 INSURER C: <br /> INSURER D <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 /> INSR ADDL SUBR POLICY EFF POLICY EXP <br /> TYPE OF INSURANCE <br /> LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ <br /> COMMERCIAL GENERAL LIABILITY DAMAGE ( RENTED <br /> PREMISES S Ea occurrence) $ <br /> CLAIMS-MADE 1:1 OCCUR MED EXP(Any one person) $ <br /> PERSONAL&ADV INJURY $ <br /> GENERAL AGGREGATE $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ <br /> POLICY PRO- LOC $ <br /> JECT <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> Ea accident $ <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> NON-OWNED PROPERTY DAMAGE $ <br /> HIRED AUTOS AUTOS Per accident <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION X WC STATU- OTH- <br /> AND EMPLOYERS'LIABILITY TORY LIMITS ER <br /> Y/N <br /> A ANY PROP RIETOR/PARTN ER/EXEC UTIVE Q921100539 08/11/2015 08/11/2016 E.L.EACH ACCIDENT $ 100,000 <br /> OFFICER/MEMBER EXCLUDED? � N/A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 <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 /> 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 /> 200 S. Cameron St. <br /> Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE <br /> ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD <br />