Agenda - 09-05-2017 - 8-k - Ratification of Manager-Approved Agreements

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DocuSign Envelope ID: 8E87460E-053E-4F51-836A-0798AA5D163E A�T IJ CERTIFICATE OF LIABILITY INSURANCE DAW(MMDO17Y) 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 Crystal Ireland NAME: y Business Insurers of Carolinas HON No. (919)968-4611 (q/C,No): (919)968-8991 C.800 Eastowne Drive, Suite 208 ADDRess:cireland @business-insurers.com PO Box 2536 INSURER(S)AFFORDING COVERAGE NAIC# Chapel Hill NC 27515-2536 _INsuRERA:Riverport- Berkley National Ins Co INSURED INSURER B:United Wisconsin Insurance Company 29157 Freedom House Recovery Center, Inc INSURER C: 104 New Stateside Drive INSURER D: INSURER E: Chapel hill NC 27516 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1771019046 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 (MMIDD/YYYY) (MMIDD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED , , A CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 1 000 000 X Professional Liability X 8527338-10 7/1/2017 7/1/2018 MED EXP(Any one person) $ 20,000 X Sexual & Physical Abuse PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 3,000,000 X POLICY PRO- 1-°C PRODUCTS-COMP/OP AGG $ 3,000,000 JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea acadent) A X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS X 8527338-10 7/1/2017 7/1/2018 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS (Per acadent) $ Medical payments $ 5,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION$ 8527338-10 7/1/2017 7/1/2018 $ WORKERS COMPENSATION x l PEATUTE l x 1 OTTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E L EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? y B (Mandatory in NH) 0400158723 5/16/2017 5/16/2018 EL.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E .DISEASE-POLICY LIMIT $ 500,000 A Employee Dishonesty 8527338-10 7/1/2017 7/1/2018 LIMIT 25,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Orange County is also an additional insured with respect to General Liability and Automobile Liability, required by written contract. Forms attached. CERTIFICATE HOLDER CANCELLATION achambers @orangecountync.g SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Health Department ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 8181 Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE J Chappell/IREL01 - ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INSO25 ro014111/