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DocuSign Envelope ID:B32F3E9F-996A-4000-8CAF-83514F2E5759 <br /> AI;°RD CERTIFICATE OF LIABILITY INSURANCE D09h6/2016 I <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 the <br /> 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 ALLAN GRAY CONTACT <br /> NAME: ALLAN GRAY <br /> PHONE [INC,FAX <br /> 1208 RALEIGH RD INC.No,Exti•919-968-0470 No):919-968-8414 <br /> StateFerm CHAPEL HILL, NC 27517 ADDRESS:Allan. rg ay.cnjzt statefarm,com <br /> INSURER(S)AFFORDING COVERAGE NAIL# <br /> _INSURER A:State Farm Fire and Casualty Company 25143 <br /> INSURED Table Ministries, Inc. INSURERS: <br /> 205 West Weaver Street INSURER C: W � <br /> Carrboro, NC 27510 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. NOTIMTHSTANDING 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 I TYPE OF INSURANCE ADOL SUER POLICY EFF I POLICY EXP LIMITS <br /> LTR _INSR. WVO POLICY NUMBER IMM/DOMYYY)'(MMIBDIYYYYI <br /> A i GENERAL LIABILITY 93-BC-Al 58-3 02106/2016 02/06/2017 EACH OCCURRENCE $ 1,000,000 <br /> DAMAGE TO RENTED <br /> X COMMERCIAL GENERAL LIAEILITY PREMISES(Ea occurrence) $ 300,000 <br /> CLAIMS-MADE X I OCCUR MED EXP(Any one person) S 5,000 <br /> I PERSONAL.&ACV INJURY 5 1,000,000 <br /> I GENERAL AGGREGATE S 2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER, PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> X POLICY 'ER,° LOC i $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> E iEa ccident) $ <br /> ANY AUTO I BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED I BODILY INJURY(Per accident) $ <br /> AUTOS , AUTOS <br /> HIRED AUTOS NON-OWNED PROPERTY DAMAGE <br /> AUTOS (Per accident) - $ <br /> -. <br /> UMBRELLA LIAR OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAR CLAIMS-MADE AGGREGATE $ <br /> J <br /> DED I RETENTIONS $ <br /> WORKERS COMPENSATION WC STATU- 'OTH- <br /> AND EMPLOYERS'LIABILITY Y!N TORY LIMITS I ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE N 7 A E.L.EACH ACCIDENT $ <br /> OFFICE/MEMBER EXCLUDED? <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> II yes,describe under E,L.DISEASE,POLICY LIMIT $ <br /> DESCRIPTION N OF OPERATIONS below Imo-�. <br /> T <br /> DESCRIPTION OF OPERATIONS!LOCATIONS f VEHICLES(Attach ACORD 101,Additional Remarks Schedule,it more space Is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> ANY OF Orange County Government THE SHOULD DESCRIBED VTHEREOF, NOTICE I WILL BE <br /> BE CANCELLED <br /> DELIVERED BEFORE <br /> IN <br /> CIO Allan Coleman ACCORDANCE WITH THE POLICY PROVISIONS, <br /> 200 S.Cameron St. ;' R <br /> AUTHORIZED REPRESENTATIVE f <br /> Hillsborough, NC 27278 /, ,/Ad. <br /> I ,. <br /> O 1988-2010 ACORD C ORATION. All rights reserved. <br /> ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 1001486 132849.8 01-23-2013 <br />