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DocuSign Envelope ID: 5ED94CEC-6251-43C9-A798-E1F25EDF371D <br /> AC®,zD® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) <br /> 1/10/2017 <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 j1Ah ECr Crystal Ireland <br /> Business Insurers of Carolinas (Arc.IN Fx) (919)968-4611 I rq cx,No),,(919)998-8991 <br /> 800 Eastowne Drive, Suite 208 App L�:cireland@business-insurers.cam <br /> PO Box 2536 INSURER(S)AFFORDING COVERAGE NAIC0 <br /> Chapel Hill NC 27515-2536 INSURERA Hamilton Mutual Insurance Co 14125 <br /> INSURED INSURER B:Employers Mutual Casualty 21415 <br /> DISPUTE SETTLEMENT CENTER INC <br /> INSURER c • <br /> 302 W WEAVER ST STE A INSURER D: <br /> • INSURER E: <br /> CARRBORO NC 27510-6004 INSURER F: <br /> COVERAGES CERTIFICATE NUMBERiCW 66315431 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. NOTWITHSTANDING 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 /> INSR ADDLISUBR POLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE RI5 NND POLICY NUMBER JMM/DD/YYM nmwooremi LIMITS <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> A CLAIMS-MADE I X I OCCUR PREMISES ETORFNTED 300,000 <br /> PREMISES fEa aurrorrce) $ <br /> 41/54487 6/17/2016 6/17/2017 MEDFECP Any one person) _$ ' 5,000 <br /> PERSONAL&ADVINJURY $ <br /> • GEM_AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> % POLICY( IjEa I LOC PRODUCTS-COMPXOPAGG $ 2,000,000 <br /> OTHER FfredlbOnewed $ 1,000,000 <br /> AUTOMOBILE LIABILITY COMBINED SINGLE UNIT $ <br /> (Pa acddent1 <br /> ANY AUTO BODILY INJURY(Pe-person) $ <br /> ALLOS�D SCHDU� BODILY INJURY(Pa'acddent) $ <br /> NON-OWNED PROPERTY DAMAGE $HIRED AUTOS AUTOS denl) <br /> S <br /> UMBRELLA LIAB _ OCCUR EACH OCCURRENCE _$ <br /> EXCESS LIAR CLAIMS-MADE AGGREGATE $ <br /> DED RETENTIONS 5 <br /> WORSENS cOMPENSAT1oN x(STATUTE I ER <br /> AND EMPLOYERS'LIABILITY <br /> OFFICER/MEMBER ofRTNE IY/NI N/A EL EACH ACCIDENT $ 100,000 <br /> B (My ON <br /> aendaabory IIneNH) 41154487 6/17/2016 6/17/2017 EL DISEASE-EA EMPLOYEE S 100,000 <br /> DESCRIPTI OF OPERATIONS below EL DISEASE-POLICY LIMIT S 500,000 <br /> • <br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Ls required) <br /> . <br /> CERTIFICATE HOLDER ' ' " ' CANCELLATION <br /> . jethompson @orangecounty7lC. ,t.'• '' t " <br /> SHOULD ANY OF TT-IEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE'; I <br /> Orange `COYlnty ''.;T..- THE E PIRATION DATE THEREOF, NOTICE WILL eE DELIVERED ile..›P-1` <br /> PO Box $ 1 AFGO12il/ZN2E WITH THE POLICY PROVISIONS. •- <br /> Fallsbough., 1VC 27278 , 042.1 ''I yu, <br /> AUTHORIZED P.FPRESENTATNE -'5 7 ?',"i.i T(q <br /> C Ireland/IRELO1 lte <br /> ©1988-2014 ACORD CORPORATION. All rights reserved, <br /> ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD <br /> INS025rnn1nn11 <br /> 1 <br />