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DocuSign Envelope ID: F9379D59-22D8-4EF4-AC91-AAC7649616BA <br /> COMMEMP OP ID: LH <br /> AWRL CERTIFICATE OF LIABILITY INSURANCE DATE(MMfDDNYYY) <br /> 0811812016 <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 Phone: 919-682-4814 NAMEACT Lee Hammond <br /> The Sergi Insurance Agency Fax: 919-682-4906 PHONE 919-682-4814 FAX <br /> 16 Consultant Place Suite 102 {a2,NNE%Em1 iNc,,wol;919.682-4906 <br /> Durham, NC 27707 E-MAIL <br /> James E.Sergi,CIC ADDRESS:lee@sorgiinsurance.com <br /> INSURER{S)AFFORDING COVERAGE NAIL <br /> INSURER A;Erle Insurance Exchange 26271 <br /> INSURED Community Empowerment Fund INSURERB: <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 /> ILTR U POLICY EFF POLICY EXP <br /> TYPE OF INSURANCE INSR WVD POLICY NUMBER <br /> [MMlDD/YYYY} IMMrDDlYYYY) LIMITS <br /> GENERAL LIABILITY <br /> EACH OCCURRENCE <br /> COMMERCIAL GENERAL LIABILITY DAMAGE TO-RENTED '------ <br /> PREMISES(Ea occurrence) $ <br /> J CLAIMS-MADE OCCUR MED EXP(Any one person) $ <br /> PERSONAL 8 ADV INJURY $ <br /> GENERAL AGGREGATE <br /> GEN'L AGGREGATE LIMIT APPLIES PER- PRODUCTS-COMP/OP AGG $ <br /> POLICY �E LOC ........ $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT . <br /> 1Eaaccudent)_.... ......_ ....$._._...----- <br /> ANY AUTO BODILY INJURY(Per person) '.S <br /> ALL OWNED SCHEDULED <br /> - AUTOS AUTOS BODILY INJURY(Per accident) S <br /> '.... '' '. <br /> HIRED AUTOS <br /> NON-OWNED <br /> UT OWNED PROPERTY DAMAGE AGE S <br /> ....__ , AUTOS (Per acclQent!_,., . .... <br /> S <br /> UMBRELLA LIAR OCCUR ,' T EACH OCCURRENCE '... $ <br /> EXCESS UAB CLAIMS-MADE AGGREGATE i $ <br /> DED RETENTION$ - $ <br /> WORKERS COMPENSATION WCSTATU- 'iOTH-� <br /> AND EMPLOYERS'LIABILITY _X.--ITOBY,„LIMIT$ ER._- ,. <br /> A ANY PROPRIETOR/PARTNER/EXECUTIVE Y r N IQ921100539 08/11!2016 08111!2017 E.L.EACH ACCIDENT $ 100,000 <br /> OFFICER/MEMBER EXCLUDED? y N/A -------.. <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 <br /> Of yes,describe under ........... ..........._.... _ . <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS I 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 /> Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> g ty 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(2010/05) The ACORD name and logo are registered marks of ACORD <br />