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DocuSign Envelope ID:91 F43AFA-8CB4-4861-887A-F304C7A6614B <br /> ` ALLIANCE OF <br /> ❑ NONPROFITS FOR ALLIANCE OF NONPROFITS FOR INSURANCE <br /> INSURANCE RISK RETENTION GROUP(ANI) <br /> www.insurancefornonprofits.org <br /> A Head for Insurance.A Heart for Nonprofits. <br /> COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS <br /> PRODUCER: POLICY NUMBER: 2015-37160 <br /> BB&T Insurance Services, Inc. <br /> P.O. Box 168 RENEWAL OF NUMBER: 2014-37160 <br /> Winston Salem, NC 27102 <br /> NAME OF INSURED AND MAILING ADDRESS: <br /> North Carolina Public Health Foundation <br /> P.O. Box 18763 <br /> Raleigh, NC 27619 <br /> POLICY PERIOD: FROM 07/19/2015 TO 07/19/2016 <br /> AT 12:01 A.M.STANDARD TIME AT YOUR MAILING ADDRESS SHOWN ABOVE <br /> BUSINESS DESCRIPTION: Public health program <br /> IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS <br /> POLICY, WE AGREE WITH YOU TO PROVIDE THE COVERAGE AS STATED IN THIS POLICY. <br /> LIMITS OF COVERAGE: <br /> GENERAL AGGREGATE LIMIT(OTHER THAN PRODUCTS-COMPLETED OPERATIONS) $2,000,000 <br /> PRODUCTS - COMPLETED OPERATIONS AGGREGATE LIMIT $2,000,000 <br /> PERSONAL AND ADVERTISING INJURY LIMIT $1,000,000 <br /> EACH OCCURRENCE LIMIT $1,000,000 <br /> DAMAGE TO PREMISES RENTED TO YOU $500,000 any one premise <br /> MEDICAL EXPENSE LIMIT 20,000 any one person <br /> ADDITIONAL COVERAGES: <br /> SOCIAL SERVICE PROFESSIONAL LIABILITY EXCLUDED <br /> CLASSIFICATION(S) SEE ATTACHED SUPPLEMENTAL DECLARATIONS SCHEDULE G <br /> PREMIUM $844 <br /> FORMS AND ENDORSEMENTS APPLICABLE TO THIS POLICY ARE INCLUDED IN COMMERCIAL LINES COMMMON POLICY DECLARATIONS <br /> 07/16/2015 BY <br /> (AUTHORIZED REPRESENTATIVE) <br /> THESE DECLARATIONS AND THE COMMON POLICY DECLARATIONS,IF APPLICABLE,TOGETHER WITH THE COMMON POLICY CONDITIONS,COVERAGE FORM(S) <br /> AND FORMS AND ENDORSEMENTS,IF ANY,ISSUED TO FORM A PART THEREOF,COMPLETE THE ABOVE NUMBERED POLICY. <br /> "NOTICE : This Policy is issued by your risk retention group.Your risk retention group may not be subject to all <br /> the insurance laws and regulations of your State.State insurance insolvency guaranty funds are not available for <br /> your risk retention group." <br /> ANI - RRG - GL (02651) <br />