2016-618-E Finance - Habitat for Humanity, Orange County, NC, Inc. - Outside Agency Performance Agreement

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DocuSign Envelope ID:A65EF081-BF54-47AC-9969-94226D3FBC7E DATE(MM/DD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE DA 73/24/2016 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 Lori Moell NAME: Summit Insurance Group, Inc. HONE Ext: (704)659-2141 A/C No: (704)659-2148 PO Box 2485 E-MAIL ADDRESS:lmoell@sumins.com INSURER(S)AFFORDING COVERAGE NAIC# Huntersville NC 28070 INSURERA:Builders Mutual Insurance Company - INSURED INSURER B:QBE Insurance Corporation Habitat For Humanity Of Orange County, NC, Inc. INSURER C: 88 Vilcom Center Dr. Ste L110 INSURER D7 INSURER E: Chapel Hill NC 27514 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1632402409 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. NOTWITHSTANDING 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 SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE RENTED A CLAIMS-MADE 1XI OCCUR PREM SESOEa occurrence) ccurrrence $ 500,000 X CPP0058155 4/1/2016 4/1/2017 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑ JECT PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER Employee Benefits $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED SCHEDULED AUTOS AUTOS PCA0009233 4/1/2016 4/1/2017 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Peracadent Medical payments $ X UMBRELLA LAB X OCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED X RETENTION$ 10,000 UM0025059 4/1/2016 4/1/2017 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE El EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED? � N/A (Mandatory in NH) WCP1024619 4/1/2016 4/1/2017 El DISEASE-EA EMPLOYE $ 1 000 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 1,000,000 B Volunteer/Accident DI NHH000489 4/1/2016 4/1/2017 $250,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Orange County Department of Housing, Human Rights & Community Developement is considered additional insured with regards to the general liability per written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County Department of Housing, THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Human Rights & Community Development ACCORDANCE WITH THE POLICY PROVISIONS. 200 S Cameron Street PO Box 8181 AUTHORIZED REPRESENTATIVE Hillsborough, NC 27278 Lori Moell/LORI ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 nmam t