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DocuSign Envelope ID: 373C6CF5-BA35-4F9B-A420-087EBFE4784E 2OCHAPEHIL3
<br /> ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) ,
<br /> 01/29/2016
<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 CONTACT
<br /> BB&T Insurance Services, Inc. NAME: Beth Wilkerson
<br /> rat, .._ .....w.
<br /> Post Office Box 13941 -Ca Nn,Ext):919 2814500 L°c,No): 888 746-8761
<br /> E-MAIL _.. - m__
<br /> Durham, NC 27709 ADDRESS: bcwilkerson@bbandt.com
<br /> 281-450© INSURER(S)AFFORDING COVERAGE NAIC#
<br /> _ .. _5_ __ m... INSURERA;Philadelphia Indemnity Insuranc 18058
<br /> INSURED
<br /> Chapel Hill Training Outreach Proj Inc INSURER B:Accident Fund Ins Co of America 10166
<br /> 800 Eastowne Dr Ste 105 INSURER C
<br /> Chapel Hill, NC 27514 INSURER O;
<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 /> INSR —.... — _.._.
<br /> ADDL SUER m"" ""—"
<br /> LTR TYPE OF INSURANCE POLICY EFF POLICY EXP
<br /> — ...... .—_. . INSR WVD.,, POLICY NUMBER (MM(DDII'YYY) (MMIDD/YYYY LIMITS
<br /> A )(� COMMERCIAL G LIABILITY - -- ) � "-- - - - -- ------ ...
<br /> GENERAL
<br /> .._ PHPK1449707 02/05/2016 02/05/201 EACH OCCURRENCE $1,000,000
<br /> DAMAGE TO RENTED
<br /> CLAIMS-MADE X OCCUR PREMISES,(Eaoccurrence) $1,000,000
<br /> MED EXP(Any one person) $20,000
<br /> -- — °--- 1 PERSONAL 8 ADV INJURY $1,000,000
<br /> GE 'L AGGREGATE.LIMIT APPLIES PER'
<br /> " '._-_
<br /> GENERAL $3,000,000
<br /> PRO- ... .....__ ...._
<br /> _ POLICY JECT „ LOC PRODUCTS COMP/OPAGG I$3,000,000
<br /> OTHER:
<br /> $
<br /> A AUTOMOBILE LIABILITY PHPK1449707 02/05/2016 02/05/201 COMBINEDSINGLE LIMIT
<br /> X accudent} $1,000,000
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> ALL OWNED SCHEDULED ..-.... .... .. .....—
<br /> AUTOS _ AUTOS BODILY INJURY(Per accident) $
<br /> X AUTOS NON-OWNED __. ... ...
<br /> HIRED AUTOS X PROPERTY DAMAGE I$
<br /> _Per accid nt
<br /> A X UMBRELLA LIAB El OCCUR PHUB529277 02/05/2016 02/05/201 EACH OCCURRENCE $1,000,000
<br /> EXCESS LIAB
<br /> _" CLAIMS-MADE
<br /> ., AGGREGATE 1,000)000
<br /> $
<br /> ..,, DED X RETENTION$1 0000
<br /> B
<br /> WORKERS COMPENSATION
<br /> AND EMPLOYERS'LIABILITY WCV6096247 12/17/2015 12/17/201* X STAPER TUTE ER—10TH-
<br /> PROPRIETOR/PARTNER/EXECUTIVE Y!N
<br /> OFFICER/MEMBER EXCLUDED? N ;N/A
<br /> (Mandatory in NH). 1 E L EACH ACCIDENT $500,000
<br /> If yes,describe under E.L.DISEASE-EA EMPLOYEE $500,000
<br /> DESCRIPTION OF OPERATIONS below EL DISEASE POLICY LIMIT 6500,000
<br /> A Professional PHPK1449707 02/05/2016 02/05/2017 $1,000,000 Occurrence
<br /> Liability $3,000,000 Aggregate
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> **Workers Comp Information**
<br /> Other States Coverage
<br /> Certificate Holder is included as Additional Insured
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> Orange County Government SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> 200 S Cameron St ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> PO Box 8181
<br /> Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE
<br /> I i V y am_, 44, •
<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 /> #S15517882/M15517856 BG3
<br />
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