2016-582-E Finance - Freedom House Recovery Center, Inc. - Outside Agency Performance Agreement

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DocuSign Envelope ID:636AFD33-DA5C-4B55-88DC-03C0863BAFE3 ACC? ° DATE(MMIDDIYYYY) ® CERTIFICATE OF LIABILITY INSURANCE 6/24/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Ellen Walker NAME: Business Insurers of Carolinas (A/C No,Eat): (919)968-4611 FAX No):(919)968^8991 800 Eastowne Drive, Suite 208 ADORless:ewalker @business-MAIL PO Box 2536 INSURER(S)AFFORDING COVERAGE NAIC C Chapel Hill NC 27515-2536 INSURER A:Union Insurance Company A+ XV 25844 INSURED INSuRERB:United Wisconsin Ins Co A- XI 29157 Freedom House Recovery Center, Inc INSURER C: 104 New Stateside Drive INSURERD: INSURER E: Chapel hill NC 27516 ,INSURER F: COVERAGES CERTIFICATE NUMBER:16/17 Revised REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD _.-_.-.. . INDICATED,..NO.TWITHSTANDING_ANY_REQUIREMENT,_TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LIMITS LTR ,INSD,WVD POLICY NUMBER IMMIDDJYYYY) (MM!DD(YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 , , DAMAGE TO RENTED A CLAIMS-MADE X OCCUR PREMISES(a occurrence) $ 1,000,000 . X Professional Liability X CPA427860742 7/1/2016 7/1/2017 MED EXP(Any one person) $ 20,000 i X sexual & Physical Abuse i PERSONAL&ADV INJURY $ 1,000,000 GE AGGREGATELIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY I PRO- JECT LOC PRODUCTS-COMP/OPAGG $ ' 3,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1 000,000 (Ea accident) r X ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED SCHEDULED AUTOS AUTOS X CPA427860792 7/1/2016 7/1/2017 BODILY INJURY(Per accident) $ X OWNED PROPERTY $X HIRED AUTOS AUT (Per accident) Medical payments $ 5,000 !, X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 _DEC I RETENTION$ CPA427860742 7/1/2016 7/1/2017 $ WORKERS COMPENSATION X STATUTE OTH- ER AND EMPLOYERS'LIABILITY Y/N j ANY PROPRIETOPJPARTNERIEXECUTIVE N!A E.L.EACH ACCIDENT $ 500,000 B OFFICER/MEMBER in N )EXCLUDED? Y 2000013393 5/16/2016 5/16/2017 EL.DISEASE-EA EMPLOYEE $ 500,000 (Mandatory[n NH) If yes,describe under DESCRIPTION OF OPERATIONS below 1 E.L.DISEASE-POLICY LIMIT $ 500,000 A Employee Dishonesty CPA427860742 7/1/2016 7/1/2017 25,000 DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES(ACORD 101.Additional Remarks Schedule,may be attached If more apace is required) Orange County is also an additional insured with respect to General Liability and Automobile Liability, • required by written contract. Forms attached. CERTIFICATE HOLDER CANCELLATION achambers @orangecountync.g SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Loo BOX 8181 ACCORDANCE WITH THE POLICY PROVISIONS. Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE Ellen Walker/ELLEN 1 e� 4 1 Oo 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025f'014m1