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DocuSign Envelope ID:0182CE2A-782E-419C-BBAF-41AC529B06BF
<br /> AC J CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)9/1/2016
<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 ACT Tammy_ Brown
<br /> NAE:
<br /> Jennings Bryan-Chappell Insurance Services (A/CNNo,Ext): (33 6)227-7458 FAX No): (336)343-1000
<br /> PO Box 1118 E-MAIL DRE '
<br /> SS: y �tamm b@ bcins.com
<br /> AD
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> Burlington NC 27216 INSURERA:Philadelphia Indeminity Ins. Co. 18058
<br /> INSURED INSURER B:United Heartland
<br /> OE Enterprises, Inc. INSURER C:
<br /> 348 Elizabeth Brady Road INSURERD:
<br /> INSURER E:
<br /> Hillsborough NC 27278 INSURERF:
<br /> COVERAGES CERTIFICATE NUMBER:CL167702198 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY)
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> DAMAGE TO RENTED
<br /> A CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 100,000
<br /> PHPK1515803 6/30/2016 6/30/2017 MED EXP(Any one person) $ 5,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY PRO-
<br /> JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> OTHER: $
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
<br /> (Ea accident)
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> A ALL OWNED SCHEDULED
<br /> AUTOS AUTOS PHPK1515803 6/30/2016 6/30/2017 BODILY INJURY(Per accident) $
<br /> NON-OWNED PROPERTY DAMAGE
<br /> X HIRED AUTOS X AUTOS (Per accident) $
<br /> Medical payments $ 5,000
<br /> X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 4,000,000
<br /> A EXCESS LIAB X CLAIMS-MADE AGGREGATE $ 4,000,000
<br /> DED X RETENTION$ 10,000 PHUB54610 6/30/2016 6/30/2017 $
<br /> WORKERS COMPENSATION PER 0TH-
<br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000
<br /> OFFICER/MEMBER EXCLUDED? N/A
<br /> B (Mandatory in NH) 2000014173 7/1/2016 7/1/2017 E.L.DISEASE-EA EMPLOYEE $ 500,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000
<br /> A Professional Liability PHSD1145531 6/30/2016 6/30/2017 1,000,000 2,000,000
<br /> A Sexual Abuse / Molestation PHSD1055405 6/30/2016 6/30/2017 1,000,000 1,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> tcomar @orangecountync.gov
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Orange County Government THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Tammy Comar ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> P.O. Box 8181
<br /> Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE
<br /> Tammy Brown/TB )i-/Yr ' ' r� (w'- -, 1.4`'.^1,1,"..,.
<br /> ©1988-2014 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
<br /> INS025 nmam i
<br />
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