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DocuSign Envelope ID: E8534F48-BEAD-4670-896E-4E8718B819E1
<br /> ___--., ARTSC-1 OP ID: MR
<br /> ACORO° DATE(MMIDDlVYYY)
<br /> CERTIFICATE OF LIABILITY INSURANCE CE 07/18/2016
<br /> 1 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 /> CONTACT
<br /> PRODUCER NAME; Chapel Hill Insurance A+gyr LLC
<br /> Summers Thompson Lowry,Inc. PHON£ SAX
<br /> 100 Europa Drive Suite 57 I P ,aP� t 919-968-4472 (A/c,No 919-942-4221
<br /> Chapel HIVI,N 27517 E.44
<br /> Luk TLlnsure co
<br /> C.Dube Thompson CPCU ARM AoDR s e m
<br /> INSURERS AFFORDING COVERAGE NAIC
<br /> INSURER A:Great American Ins Co of NY
<br /> INSURED The Arts Center Inc. INSURER B:FFVA Mutual Insurance Co.
<br /> 300 G East Main Street
<br /> Carrboro,NC 27510 INSURER C:Great American Alliance Ins Co
<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 /> IL R S A b PobOY EFF POLICY EXP
<br /> TYPE OF INSURANCE III I POUCY NUMBER MMIDD ) IMMIDDIYYYY) LIMITS
<br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> DAMAGE TQ illP4r f
<br /> A X COMMERCIAL GENERAL LIABILITY PAC4296967 07/01/2016 07/01/2017 PPEvisEsjLau Curren ) $ 100,000
<br /> CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 5,000
<br /> PERSONAL&ADVINJURY $ 1,000,000
<br /> GENERAL AGGREGATE $ 2,000,000
<br /> GEN°L AGGREGATE LIMIT APPLIES PER: PRODUCTS $ 2,000,000
<br /> POLICY
<br /> PRD LOC Emp Ben. $ 1,000,000
<br /> AUTOMOBILE LIABILITY
<br /> COMBINED IadNraLE LIMIT
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> ALL OWNED -- 'I SCHEDULED BODILY INJURY(Per accident) $
<br /> ,,,.,.. AUTOS NON-OWNED OP$6`(`1'DAMAor
<br /> HIRED AUTOS ,..... AUTOS r�ERAI"�G1DI�Nn�,,,, $
<br /> X EXCESS AB AB X CLAIMS MADE UMB4296968 07/01/2016 07/01/2017 G AGGREGATE OCCURRENCE $ 1,000,00l
<br /> � q � 1
<br /> DED J X RETENTION$ 10000
<br /> WORKERS COMPENSATION WC STATU- IOTH
<br /> AND EMPLOYERS'LIABILITY ,TORY t(„(y11T$ x,.ER
<br /> Y I N
<br /> B ANY PROPRIETOR/PARTNER/EXECUTIVE WC8400032267 01/01/2016 01/01/2017 E EACH ACCIDENT $ 500,000
<br /> OFFICER/MEMBER EXCLUDED? N IA
<br /> (Mandatory in NH) E .DISEASE-EA EMPLOYEE $ 500,0001
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 500,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required)
<br /> For Information Purposes
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> ORANGE2
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Orange County ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Human Services Dept.
<br /> PO Box 8181 AUTHORIZED REPRESENTATIVE
<br /> Hillsborough, NC 27278 / gal �JI ,�'
<br /> C. G
<br /> ©1988-2010 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD
<br />
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