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 AC°® CERTIFICATE OF LIABILITY INSURANCE DATE{MMIDDIYYYY) k,....---- 9/13/2016 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). PRODUCER CONTACT Tracie Hawkins NAME: FAX The Phoenix Company, LLC (PpHlONr o.Exn: (336)765-9332 AIC.N01;(336)765-714E P.O. Box 26396 E-MAIL DRE tracieh @thephoenixcompany.COM ADSSI . ..,.... INSURER(S)AFFORDING COVERAGE NAIC B Winston-Salem NC 27114-6396 INSURERABerkshire Hathawa S•ecialt, 22276 INSURED INSURER B: Exchange Club Center for the Prevention of INSURER C: Child Abuse of North Carolina INSURERD: 500 West Northwest Boulevard INSURERE: Winston-Salem NC 27105 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1642549305 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER IMMIDDIYYYYL(MM!DD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $A CLAIMS-MADE X OCCUR 47SPK14916101 4/12/2016 4/12/2017 MED EXP(Any one person) $ 20,000 PERSONAL.&ADVINJURY $ 1,000,000 _ GENERAL AGGREGATE $ 3,000,000 GEN'L.AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 3,000,000 X POLICY PRO-.I LOC $ FCT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 ",_ (Ea accident) _.�_. X ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED SCHEDULED 47RWS14916201 4/12/2016 4/12/2017 BODILY INJURY(PeraccAdent) I AUTOS AUTOS X NON-OWNED PROPERTY DAMAGE ci $ HIRED AUTOS AUTOS IPer accident)) ....................�______..__ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION .,. WC STATU- OTH- AND EMPLOYERS'LIABILITY Y I N TORY LIMITS FR ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E L.DISEASE- EMPLOYEE $ If yes,describe under ........_ - w...— _ ____ DESCRIPTION OF OPERATIONS below E _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 47SPK14916101 4/12/2016 4/12/2017 $1D0,000Each Occurrence $300,000 Aggr DESCRIPTION OF OPERATIONS/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 <7 ■ ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025l,onnnw nt Tha ernon name and Irwin ara ranicdararl mark of Ar't'1Rrl