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DocuSign Envelope ID: 3D9A2C3C-B477-4E3B-886F-5583C52FF19A
<br /> Client#: 1232534 20LIFESKI ,
<br /> MlDO/YYYY)
<br /> (M
<br /> ACORD., CERTIFICATE OF LIABILITY INSURANCE DATE TE(M /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.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 /> PRODUCER NAME: Beth Wilkerson
<br /> BB&T Insurance Services,Inc. PHONE FAX
<br /> {Arc,No,E�Z919 281-4560 iAr No). 8887468761
<br /> Post Office Box 13941 EMAIL
<br /> ADDRESS: bcwilkerson@bbandtcom
<br /> Durham, NC 27709 INSURER(S)AFFORDING COVERAGE NAIC 0
<br /> 919 281-4500
<br /> INSURER A:Philadelphia Indemnity Insuranc 18058
<br /> INSURED INSURERS:
<br /> LIFE Skills Foundation
<br /> INSURER C
<br /> 2670 Durham Chapel Hill Rd �._.
<br /> Durham,NC 27707 INSURER D:
<br /> INSURER E
<br /> INSURER F:_ e 1
<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 /> LTR TYPE OF INSURANCE LIMITS
<br /> .- „ .._.._.—_ INSR MD .__.. POLICY NUMBER ._.....__.[MMlDDlYYYY MMlDD1YYYY} _..
<br /> A X COMMERCIAL GENERAL LIABILITY PHPK1396797 19/15/2015 09/15/201;EACH OCCURRENCE $1,000 000
<br /> DAMAGE TO RENTED
<br /> CLAIMS-MADE 1 X OCCUR PREMISES Ea occurrence $100,000
<br /> MED EXP(Any one person) $5,000
<br /> PERSONAL&ADV INJURY $1,000 000
<br /> GE 'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $3,000,000
<br /> PRO- 1
<br /> POLICY JECT I LOG
<br /> PRODUCTS-COMPIOPAGG '$3,000,000
<br /> OTHER: ....._..__....,.........__.'..S
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT I
<br /> Ea acodena.._..____..._......._.........__ S
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> ALL OWNED I SCHEDULED P_._...a_.___ ,__
<br /> AUTOS AUTOS BODILY INJURY I,Perccidontt 5
<br /> nt)
<br /> ..- ........_.................... _
<br /> NON-OWNED PROPERTY DAMAGE $
<br /> HIRED AUTOS AUTOS Per accident.
<br /> S
<br /> P UMBRELLA,LIAB OCCUR EACH OCCURRENCE
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE S
<br /> .._....,-.. DEO RETENTION$ S
<br /> WORKERS COMPENSATION ■PER
<br /> AND EMPLOYERS'LIABILITY Y!N 1 Fig
<br /> ANY PRCPRIETORIPARTNEREXECUTIVE E.L.EACH ACCIDENT $
<br /> OFFICER/MEMBER EXCLUDED? N I A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S
<br /> If yes,describe under
<br /> ,DESCRIPTION OF OPERATIONS below „”,,,,,,, ,_,,,.,_.,,,.._-_-_ _ E.L.DISEASE-POLICY LIMIT $
<br /> A (Abuse/Molestation PHPK1396797 +9/15/2015 09/15/201. $50,000/$100,000
<br /> A Professional Liab PHPK1396797 '115/2015 9/15/2016 $1 Mil/$3Mil
<br /> DESCRIPTION OF OPERATIONS(LOCATIONS(VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> Oran a CDUn De artment of SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> g ty p THE EXPIRATION DATE THEREOF, NOTICE WILL BE. DELIVERED IN
<br /> Social Services ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 113 Mayo Street
<br /> Hillsborough,NC 27278 AUTHORIZED REPRESENTATIVE
<br /> ©1988-2014 ACORD CORPORATION.All rights reserved.
<br /> ACORD 25(2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD
<br /> #S16429102/M16429096 AB4
<br />
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