2017-078-E DSS - The Exchange Club's Familv Center in Alamance - Outside Agency Performance Agreement

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DocuSign Envelope ID:AB039DC1-8309-4D41-B525-6E84F973FAA6 ACC•R Et CERTIFICATE OF LIABILITY INSURANCE DATE`MM'DD"m" 4/25/2016 TI-US 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 poiicy(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 C6}INAId7A E; TI racie Hawkins The Phoenix Company, LLC iCNN Exri: (336)765-9332 7 CF ry Nol:(336}765-7141 P.O. Box 26396 ADpa x,tracieh @thephoenic mpany.com ..... INSURER(5)AFFORDING COVERAGE NAIL N Winston-Salem NC 27114-6396 INsuRERABerkshire Hathaway Specialty 22276 INSURED INSURERS; Exchange Club Center for the Prevention of INSURER c: - Child Abuse of North Carolina INSURER 0: 500 West Northwest Boulevard INSURERE: Winston-Salem NC 27105 _INSURER F: , COVERAGES CERTIFICATE NUMBERCL1642549305 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. NSA ADDL SUER POLICY CFP pQ_u� v EXP LTR TYPE OF INSURANCE INSR VIVO POLICY NUMBER (MMIDDJYYYY) (M LIMITS GENERAL LJABILnY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LABILITY prianI E70 RENTED 1 000,000 PR�r11SES(Ea occurrence) $ , A CLAIMS-MADE I X 1 OCCUR 478PR14916101 4/12/2016 4/12/2017 ME.DEXP(Any one person) $ 20,000 PERSONAL&ADV INJURY $ 1,000,000 GENCICAL AGGREGATE $ 3,000,000 GEM_AGGREGATE LIMIT APPLIES PER: } j, PRODUCTS-COMP/OP AGG $ 3,000,000 X POLICY 7 IFC"T LOC 1 4 � $ AUTOMOBILE UABtLI1Y lO MGIHE SINGLE LIMIT -$ 1,000,000 A X ANY AUTO `t6ODILY INJURY(Per person) 3 ALL OWNED SCHEDULED 7RW814916201 4/12/2016 4/12/2017 BODILY INJURY(Per acciderri) $AUTOS X UwKED ED AUTOS PRO G5cry DA AGE $ UMBRELLA LIAR OCCUR. i EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ • DED , RETENTIONS ( $ WORKERS COMPENSATOR WCSTATU• : OYH- AND EMPLOYERS'LIABILITY V 1 N *p` ,,.. ANY PROPRIETOR/PARTNER'EXECUTIVE- N}A EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) EL DISEASE-EA EMPLOYEE $ If yes.describe under DESCRIPTION OF OPERATIONS below ... ,m. E.L.DISEASE-POUCY UMIT $ A Professional Liability 47SPx14916101 4/12/2016 4/12/2017 $.000000 Each Occurrence $3,000,000 Ag A SexAbuse/Molestation Liab 478MM/4916101 4/12/2016 4/12/2017 $'00,000 Each Occurrence $300,000 Aggr DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 501,Additional Remarks Schedule,if wore space Is requited) CERTIFICATE HOLDER CANCELLATION (336)714-9367 adavis@cphs.org SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERS) IN CenterPoint Human Services ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Anne Davis •- 4045 University Parkway AUTHORIZED REPRESENTATIVE Winston-Salem, NC 27106 T Hawkins, CISR/HAWCI � ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 mmnwsi ni Tho Art 11711 name anal Inn's arc.ronl r$ora d marlr raf ARr1Rri