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DocuSign Envelope ID:82431AC9-7F03-4084-815E-A2EFB34C92BB
<br /> INTECOU-01 KDAVIS
<br /> ,4c0R1fJ CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
<br /> 9/23/2016
<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 /> NAME:
<br /> Summers Thompson Lowry,Inc. PHONE 919 968-4472 FAX 919 942-4221
<br /> 100 Europa Drive (A/C,No,Ext):( ) (A/C,No): ( )
<br /> Suite 571 E-MAIL info @STLinsure.com
<br /> Chapel Hill,NC 27517-2393 ADDRESS:
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURER A:Alliance for Non-Profits for Insurance Risk Retention Group
<br /> INSURED INSURER B:Association Insurance Company
<br /> Inter-Faith Council for Social INSURER C:Hartford Fire Ins. Co.
<br /> Service Inc.
<br /> 110 W.Main Street INSURER D:The Hanover Ins Co
<br /> Carrboro,NC 27510 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 /> R TYPE OF INSURANCE ADDL WVD POLICY NUMBER POLICY EFF POLICY EXP
<br /> T LIMITS
<br /> (MM/DDIYYYY) (MM/DDIYYYY)
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X OCCUR X 201517838 07/01/2016 07/01/2017 DAMAGE TO RENTED 500 000
<br /> PREMISES(Ea occurrence) $
<br /> X Professional 1 M/2M MED EXP(Any one person) $ 20,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY PRO-
<br /> JECT LOC PRODUCTS-COMP/OP AGG $ 2,000 000
<br /> JECT �
<br /> OTHER: Employee Ben $ Included
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1 000 000
<br /> (Ea accident) > >
<br /> A X ANY AUTO 201517838 07/01/2016 07/01/2017 BODILY INJURY(Per person) $
<br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS AUTOS
<br /> NON-OWNED PROPERTY DAMAGE
<br /> HIRED AUTOS AUTOS (Per accident)
<br /> $
<br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000
<br /> A EXCESS LIAB CLAIMS-MADE X 201517838UMB 07/01/2016 07/01/2017 AGGREGATE $ 1,000,000
<br /> DED X RETENTION$ 1 0,000 $
<br /> WORKERS COMPENSATION X PER OTH-
<br /> AND EMPLOYERS'LIABILITY STATUTE ER
<br /> Y/N
<br /> B ANY PROPRIETOR/PARTNER/EXECUTIVE WC522-000320-115 07/01/2016 07/01/2017 E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBER EXCLUDED? N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
<br /> C Crime/ERISA 22BDDHK5511 07/01/2016 07/01/2017 100,000
<br /> D D&O/EPLI LHR8785106 07/01/2016 07/01/2017 1,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> It is understood and agreed that the certificate holder is included as additional insured as respects General Liability as required by written contract.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Orange County Government THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> g ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> PO Box 8181
<br /> Hillsborough,NC 27278
<br /> AUTHORIZED REPRESENTATIVE
<br /> csac i F 5,.vvr$rw,,e,g
<br /> ©1988-2014 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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