2016-621-E Housing - Communication Services for Deaf and Hard of Hearing - ASL & Transliteration

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DocuSign Envelope ID: EE0D7A24-3C3D-485C-AE8B-53FC4F6128E1 / , ® DATE (MMfODIYYYY) i ACORO CERTIFICATE OF LIABILITY INSURANCE 3/25/2016 i 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 Phyllis Carter, CIC, CISR Insurance Center PHOONN,ESb (336)375-0600 (ac,Nol;(336)375-7004 823 North Elm Street E-MAIL ADDRESS:p carter @craftinsurance,com • PO Box 14946 INSURER(S)AFFORDING COVERAGE NAIC# Greensboro NC 27415 INSURERA:Selective Ins, Co.' Of America 12572 INSURED INSURER B:Hartford Property & Casualty 34690 Guilford County Communications Center INSURER C: GIs The Deaf and Hard of Hearing, Inc. INSURER D: 1175 Revolution Mill Drive, Suite 15 INSURERS: it Greensboro NC 27405-5079 INSURER F: COVERAGES CERTIFICATE NUMBER: 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 IN SD WVD POLICY NUMBER IMMIDDIYYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S_. 1,000,000 DAMAGE TO A CLAIMS-MADE X OCCUR PREMISES(Ca occurrence) S 1629360 12/6/2015 12/6/2016 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY PE9 I i LOC PRODUCTS-COMP/OP AGG _$ 3,000,000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 5 (Ea accident) ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE S DED RETENTIONS S WORKERS COMPENSATION X O PERTUTE ETH AND EMPLOYERS'LIABILITY E.L.EACH ACCIDENT 5 500 000 ANY OFFI ER/MEMBER EXCLUDEECUTiVE I D? YNN. N I A B (Mandatory,In NH) 22WBCCI6834 4/26/2016 9/26/2017 E.L.DISEASE-EA EMPLOYEE $ 500,000 Eyes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION (919) 969-4777 sclifford @orangecountync.g SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CSDHH THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Southern Human Services Center ACCORDANCE WITH THE POLICY PROVISIONS, Susan Clifford, MSW, MPH 2501 Homestead Road AUTHORIZED REPRESENTATIVE Chapel Hill, NC 27516 — - P Carter, CIC, CISR/P /_:. ©1988-2014 ACORD CORPORATION, All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 0514511