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DocuSign Envelope ID: E9553E7D-3748-4C37-A9D7-602D42934ACC <br /> 1 OP ID:SF <br /> coRO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) <br /> `••--°''� 09/15/2016 <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 /> Lee-Moore Insurance Agency Inc PHONE FAX <br /> P.O.Box 667 (A/C,No,Ext): (A/C,No): <br /> West End,NC 27376 E-MAIL <br /> Alex Maiolo ADDRESS: <br /> PRODUCER PUBLI-1 <br /> CUSTOMER ID#: <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURED Public Gallery of Carrboro Inc INSURER A:Hartford Insurance 14397 <br /> Ruffin Slater <br /> 201-A N Greensboro St INSURER B <br /> Carrboro, NC 27510 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 /> IN SR TYPE OF INSURANCE I POLICY EFF POLICY EXP <br /> INSR WVD POLICY NUMBER /Y LIMITS <br /> (MM/DD YYY) (MM/DD/YYYY) <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> A X COMMERCIAL GENERAL LIABILITY 22SBABG0187 06/03/2016 06/03/2017 DAMAGE TO RENTED <br /> PREMISES(Ea occurrence) $ 300,000 <br /> CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 10,000 <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GENERAL AGGREGATE $ 2,000,000 <br /> GE 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> POLICY PRO- <br /> JECT LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> (Ea accident) <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED AUTOS BODILY INJURY(Per accident) $ <br /> SCHEDULED AUTOS <br /> PROPERTY DAMAGE <br /> HIRED AUTOS (PER ACCIDENT) <br /> NON-OWNED AUTOS $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DEDUCTIBLE $ <br /> RETENTION $ $ <br /> WORKERS COMPENSATION X WC STATU- 0TH- <br /> AND EMPLOYERS'LIABILITY TORY LIMITS ER <br /> Y/N <br /> A ANY PROPRIETOR/PARTNER/EXECUTIVE 22WECPD4664 06/03/2016 06/03/2017 E.L.EACH ACCIDENT $ 100,000 <br /> OFFICER/MEMBER EXCLUDED? N/A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/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 /> a County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Oran <br /> g ty ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Allison Chambers <br /> 200 S Cameron St <br /> Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE <br /> Alex Maiolo <br /> ©1988-2009 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD <br />