2017-220-E Housing - Habitat for Humanity of Orange County, NC, Inc. - Agreement for HOME Consortium for FY 2016-17

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DocuSign Envelope ID: 658056BB-F456-432C-AF1 E-905B0A4F4326 A�RI DATE(MM/DD/YYYY)® CERTIFICATE OF LIABILITY INSURANCE 3/20/2017 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 Lori Short NAME: Summit Insurance Group, Inc. (A//� o Ext) (704)659-2141 FAX NO): (704)659-2148 PO Box 2485 E-MAIL ADDRESS:lori @sumins.com INSURER(S)AFFORDING COVERAGE NAIC# Huntersville NC 28070 _INSURERA:Builders Mutual Insurance Company - 10844 INSURED INSURER B:QBE Insurance Corporation 39217 Habitat For Humanity Of Orange County, NC, Inc. INSURERC: 88 Vilcom Center Dr. Ste L110 INSURERD: INSURER E: Chapel Hill NC 27514 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1732003047 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 SUER POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED , A CLAIMS-MADE X OCCUR 500 000 PREMISES(Ea occurrence) $ X CPP0058155 4/1/2017 4/1/2018 MED EXP(Any one person) $ 5,000 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- LOC PRODUCTS-COMP/OPAGG $ 2,000,000 JECT OTHER: Employee Benefits $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) A X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED PCA0009233 4/1/2017 4/1/2018 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS (Per accident) „$ Medical payments $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 DED X RETENTION$ 10,000 MUH0001005 4/1/2017 4/1/2018 $ WORKERS COMPENSATION x EOTH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N N/A A (Mandatory in NH) PWC1011231 4/1/2017 4/1/2018 E L D I S E A S E E A E M P L O Y E E $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E .DISEASE-POLICY LIMIT $ 1,000,000 B Volunteer/Accident DI NHH000489 4/1/2017 4/1/2018 $250,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Orange County Department of Housing, Human Rights & Community Developement is considered additional insured with regards to the general liability per written contract. CERTIFICATE HOLDER CANCELLATION CCandora-Hickey @orangehabi SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County Department of Housing, THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Human Rights & Community Development ACCORDANCE WITH THE POLICY PROVISIONS. 200 S Cameron Street PO Box 8181 AUTHORIZED REPRESENTATIVE Hillsborough, NC 27278 ,� Lori Short/LORI � 7 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)