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DocuSign Envelope ID:87560079-2786-4376-A189-DC48D9482BE7 1
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<br /> ACOREP CERTIFICATE OF LIABILITY INSURANCE [SATE(rAM106lYYYY)6/23/201.7
<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(tes) must be endorsed. If SUBROGATION 1S WAIVED,subject to
<br /> Me terms and conditions of the-policy,certain policies may require an endorsement. A statement on this certificate dons not confer rights to the
<br /> certificate holder In lieu of such endorsement(s). ,
<br /> PRODUCER C rrACT Traoie Hawkins
<br /> NAME;
<br /> The Phoenix Company, LLC F1210,Fxn: (336)765-9332 IMa,NO(336)765-7191
<br /> P.O. Box 26396 aonFIlE„,tracieh @thephoers.ixaompany.com
<br /> INSURER(S)AFFORDING COVERAGE NAIL A
<br /> Winston-Salem NC 27114.6396 €NSURERABerkshire Hathaway Specialty 22276
<br /> INSURED INSURER BWe9C0 Insurance Company 25011
<br /> Exchange Club Center for the Prevention of INSURER C:
<br /> Child Abuse of North Carolina INSURER D:
<br /> 500 West Northwest Boulevard INSURERE:
<br /> Winston--Salem NC 27105 INSURER E: _
<br /> COVERAGES CERTIFICATE NUMBER:CL17 51 64 642 REVISION NUMBER:
<br /> '-s
<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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
<br /> LTR INSR Vain POLICY NUMBER (MM!DDIYYYY1 (MM)DD!YYYYI
<br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> DAMAGE TO X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence)rental S 1,000,00 0 .,,
<br /> A CLAIMS-MADE Fd OCCUR 47SPK14916102 4/12/2017 4/12/2018 MED EXP(Any ane person) $ 20,000
<br /> PERSONAL&ADVINJURY $ 1,000,000
<br /> GENERAL AGGREGATE $ 3,000,000 11
<br /> GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 3,000,000
<br /> (
<br /> I POLICY Tim PRO [ LOC b
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
<br /> (Ea accident) S 1,000.000
<br /> A X ANY AUTO BODILY INJURY(Per person) $
<br /> ALL OWNED ■SCHEDULED 471=14916202 4/12/2017 4/12/2018 BODILY INJURY(Pea accident) $
<br /> ' HIRED AUTOS © NON-OWNED OS (PerraEdRdnnt)dMAGE $
<br /> $
<br /> UMBRELLA L1AB _OCCUR EACH OCCURRENCE 3
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ .
<br /> DED I I RETENTIONS $
<br /> WORKERS COMPENSATION x I WC STATU• I 10T11-
<br /> AND EMPLOYERS'LIABILITY Y!N TORY LIMITS I ER
<br /> WWC3259691 1/27/2017 1/27/2018 E.L.EACH ACCIDENT $ 100 000,
<br /> ANY PROMEMBERtEXCLUDRlF>(ECUTIVE I N N 1 A L
<br /> OFFICERIMEMBER ER ExDLUD6D7
<br /> - B (Mandatory In NH) 'E.L.DISEASE-EA EMPLOYEE 5 100,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below -EL DISEASE-POLICY LIMIT,$ 500,000
<br /> A Professional Liability 47SPK14916102 4/12/2017 4/12/2919 $1.0o0,000 Each incldeni $3,000,000 Ag
<br /> A Abuse/Molestation Liab. • 47sPK14916102 4/12/2017 4/12/2018 $100,000 Each Event $300,000 Aggr
<br /> DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If mere space is required) [
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<br /> CERTIFICATE HOLDER CANCELLATION
<br /> j
<br /> (336)7149367 adavis@cphs.org SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE §
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS. I
<br /> CenterPoint Human Services • '
<br /> Attn; Anne Davis )
<br /> 4045 University Parkway NORIZEDREPRESENTATIVE
<br /> I
<br /> AUT
<br /> Winston--Salem, NC 27106 1
<br /> T Hawkins, CISR/HATTlC2 u ,
<br /> ACORD 25(2010105) @1988-2010 ACORD CORPORATION. All rights reserved, ,/
<br /> INS025I7nsnnnenl The.Arnizn Hama and innn a,A,Arne+Arcri marks nr Ar_r1R17 I
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