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 0 DATE(MM�IDDlYYYY} A ° CERTIFICATE OF LIABILITY INSURANCE 8,13,2016 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). . CONT PRODUCER NAMEACT Tracie Hawkins The Phoenix Company, LLC IAICNNO Esti: (336)765-9332 (AIG.N01:(336)765-7141 P.O. Box 26396 ADDRESS:tracieh @thephoenixcompany.com INSURER(S)AFFORDING COVERAGE NAIC# Winston—Salem NC 27114-6396 INSURER A Berkshire Hathaway Specialty 22276 INSURED INSURER B: 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 WTH 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 ADDL SUER POLICY EFF POUCY EXP TYPE OF INSURANCE LTR INSR WVD POLICY NUMBER IMMIDDIYYYY) (MMIDI))YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ A CLAIMS-MADE -OCCUR 47$PK14916101 4/12/2016 4/12/2017 MED EXP(Any one person) $ 20,000 PERSONAL a ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-C OMP/OP AGG $ 3,000,000 X POLICY JFC LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (La accident) S 1,000,000 X ANY AUTO BODILY INJURY(Per person) S A ALL OWNED SCHEDULED 47RWS14916201 4/12/2016 4/12/2017 BODILY INJURY(Per accident) S AUTOS AUTOS - - - X HIRED AUTOS NON-OWNED _(PPRPERTY nt) $ • UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y!N TORY LIMITS FR ANY PROPRIETOR/PARTNER/EXECUTIVE - N!A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E,L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Professional Liability 47SPK14916101 4/12/2016 4/12/2017 $1,000,000 Each Occurrence $3,000,000 Ag A SexAbuse/Molestation Liab 47$PK14916101 4/12/2016 4/12/2017 $100,000 Each Occurrence $300,000 Aggr DESCRIPTION OF OPERATIONS f LOCATIONS)VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) '..... CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Chapel Hill ACCORDANCE WITH THE POLICY PROVISIONS. A North Carolina Municipal Corporation 405 Martin Luther King Jr Blvd AUTHORIZED REPRESENTATIVE Chapel Hill, NC 27514 T Hawkins, CISR/HAWKI ACORD 25(2010105) @ 1988-2010 ACORD CORPORATION. All rights reserved. INS025 fontnn5i 01 The Arnpn name.anri Inn^arc rcnietereri marl,¢of Arnim