|
DocuSign Envelope ID: DB07BCBB-97D7-4769-AF8A-905711BEFAD9
<br /> Client#:510480 20YMCATRI
<br /> PATE(Mk'JDDNYYY)
<br /> ACORDTM CERTIFICATE OF LIABILITY INSURANCE 4104/2016
<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.T1I1S CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE CONTRACT`BETWEEN THE ISSUING INSURER(S),AUTHORIZED
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> mWdRTA4T:If the certificate holder is an ADDITIONAL INSURED,the policy(les)€ ust be endorsed.It 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 NTA T Debbie Church .
<br /> NAME:PHONE Ext� _,
<br /> BB&T Insurance Services,Inc. 9-10-772-3720- FAX` 888-746-8761
<br /> - Air No AtC,Nn
<br /> Post Office Box 13941 E-MAIL
<br /> ADDRESS:
<br /> Durham,NC 27709 €NSURER($)AFFORDING COVERAGE NAic#
<br /> 919 281-4500 North River Insurance Company 21105
<br /> ..INSURER R: p y
<br /> INSURED. - INSURER R:Pennsylvania Manufacturers Asso 12262
<br /> The YMCA of the Triangle Area Inc INSURER G:Travelers Casualty&Surety Co, 31194
<br /> 801 Corporate Center Or Ste 200 RD _.._..._.
<br /> Raleigh,NC 27607 INSURER D,American Guarantee&Liabilify __...,.. 26247
<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 TOITHF 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 ADDLSUBR POLL€GY FP POLICYE}CP
<br /> LTft TYPEOFINSURANCE- i SR WVD POLICY NUMBER MM1DOlY YY MI)L7DlYYY Lli19rTS
<br /> A COMMERCIAL GENERAL IJAB€LrCY X 5068846197 4/0112016 04/01/2017 EACHoccURRENcE $10000 0
<br /> F 7V DAMA�,E RENTED
<br /> CLAIMS-MADE OCCUR .. PREFrFISEa Ea4ccur nee
<br /> $1,000,000
<br /> I ; MED EXP(Anyone person} $5.000
<br /> i PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER; GENERALAGGREGATE $3,000000
<br /> �'i PRC3•
<br /> POLICY FJECT I LOG PRODUCTS-CO MPA)PAGG $1,000,000
<br /> _.I OTHER:- ., $
<br /> .AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT R 5068846197 4!01!2016 04101/209 Eaacuident 1,000,000
<br /> XIX I ANY AUTO BODILY INJURY(Pnrpeason) S---��-
<br /> AUTOSNED SCHEDULED
<br /> AUTOS BODILY INJURY(Per accident) 6
<br /> NON-OVdNEO PROPERTY OAM,4t3C --'_�__.___
<br /> HIRED AUTOS AUTOS $
<br /> _ $
<br /> UMBRELLA LIAR OCCUR EACH OCCURRENCE $
<br /> EXCESS LIA'R' OkAIMS•tRADE. AGGREGATE $
<br /> DED I RETENT€ONSY,LA .°
<br /> B WORKERS COMPENSATION 2016750449900 4/01/2016 041011201 X PTR OTH-
<br /> AND EMPLOYERS'LIABILITY
<br /> Y
<br /> PH
<br /> t N
<br /> ANY PROPRIETORtPARTNER/EXEOUTIVE E.L.EACH ACCIDENT $500,000
<br /> OFFICERIME€SEREXCLUDED? �.NIA [ ..--
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE$500,OOD
<br /> d yes,describe under
<br /> DESCRIPTION DF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $500 000
<br /> C Employee Theft 105763974 E/01/2016104/01/201 101/2016 04/01121)19& 3,000,000 per occ
<br /> C Computer Fraud 105763974 /01/2016 04/0112011, 3,000,000 per oce
<br /> C Funds Transfer 105763974 3: 3,000,000 per oac
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 141,Additional Remarks Scheduler may he attached It more space Is required)
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> Orange County Human Services SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Outside Agency Funding ACCORDANCE WITH THE POLICY PROVISIONS",
<br /> 200 South Cameron St
<br /> PO Box 8181 AUTHORIZED REPRESENTATIVE
<br /> Hillsborough,I G 27278
<br /> 01 88-2014 ACORD CORPORATION.All rights reserved.
<br /> ACORD 25(20W01) 1 of 1 The ACORD name and logo are registered marks of ACORD
<br /> #815958423/Ml 5955609 JAW
<br />
|