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DocuSign Envelope ID:AA4A654B-B3E1-4DEC-A4D2-76D201AFBD1C
<br /> AC4OREP CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DEVYYYY)
<br /> 441,,,.......---- 9/19/2016
<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 Margretta Pal a, AAI
<br /> Hum
<br /> g y
<br /> The Novick Group PHONE (301)795-6600 FAX Not,I30u79s-6610
<br /> One Church Street E-MAIL mpalya @novice rou com
<br /> Suite 400 INSURERLS)AFFORDING COVERAGE NAICA
<br /> Rockville MD 20850 INSURER A:Westchester Surplus Lines 10172
<br /> INSURED INSURERB,AIG Specialty 26883
<br /> Rebuilding Together, Inc. and Its Affiliates INSURER C:
<br /> 1899 L Street, NW INSURER 0: ._._. .._._ ._. ... ......._
<br /> Suite 1000 INSURER E:
<br /> Washington DC 20036 INSURER F:
<br /> •
<br /> COVERAGES CERTIFICATE NUMBER:Aff GL, Exc, CPL 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. NOTVVITHSTANDING 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 /> TAD0L SUER POLICY EFF --POLICY EXP-_ .... _..... ..............
<br /> TYPE OF INSURANCE IMM(DD/YYYYI LIMITS
<br /> A CLAIMS-MADE [X OCCUR EACH OCCURRENCE $ 1,000,000
<br /> X COMMERCIAL GENERAL LIABILITY 1 EACHO TO RENTED
<br /> ENCE
<br /> LTR '�INSD MD l M/D
<br /> PREMISES occurrence), $ 150,000
<br /> X 024064116008 3/15/2016 , 3/15/2017 MEDEXP(Any one person) $ 5 000
<br /> PERSONAL&ADV INJURY 1$ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE 5 2,000,000
<br /> POLICY((X 2,000,000
<br /> ) L JEC f [ ,�1.00 � �PRODUCTS:COMP/OP A00 $
<br /> 1 OTHER'. Property Deductible $ 1,000
<br /> AUTOMOBILE UABILITY COMBINED SINGLE LIMIT $
<br /> (Ea accident)._
<br /> t
<br /> ,ANY AUTO BODILY INJURY Per person) $
<br /> _ +
<br /> 'ALL OWNED • SCHEDULED, ., INJURY_...,. ... ,
<br /> AUTOS (Peracc accident) $ .,
<br /> NON-OWNED PROPERTY DAMAGE $
<br /> HIRED AUTOS i ,.AUTOS Veer accident),
<br /> $
<br /> I UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000
<br /> A X EXCESS LIAR CLAIMS-MADE AGGREGATE $ 560006000_
<br /> DED 1 1 RETENTION
<br /> G21980201010 3/15/2016 3/15/2017 ' IS
<br /> WORKERS 1 1 ( I MUTE i `0H
<br /> AND EMPLOYERS'LIABILITY
<br /> Y/N�
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER ELL EACH ACCIDENT S
<br /> (Mandatory IC ER EXCLUDED'? [ _,N A - -
<br /> (Mandatory In NH) E L DISEASE EA EMPLOYEE $
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT 1$
<br /> B Contractors Pollution III CPL17663214 3/15/2016 3/15/2017 Limit $1,000,000
<br /> Deductible $25,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required)
<br /> Rebuilding Together of the Triangle is a Named Insured on the above policies.
<br /> Orange County, NC is an Additional Insured but only with respect to claims arising out of the operations
<br /> of the Named Insured.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Orange County, NC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> 200 South Cameron Street ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> P.O. Box 8181
<br /> Hill sborough, NC 27278 AUTHORIZED REPRESENTATIVE
<br /> Louis Novick/RUTH ✓" - ---•-. ....100"72,_
<br /> O 1988-2014 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
<br /> INS025(2014011
<br /> (Rebuilding Together the Triangle,Inc.)
<br /> Orange County Outside Agency Performance Agreement Page 9 of 7
<br /> Rev. 6/15
<br />
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