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DocuSign Envelope ID: 1A43D806-0D44-4AC1-898C-3042FDBCA241
<br /> CHILCAR-02 DWILSON2
<br /> ,a►CC)RC1" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
<br /> `••---'' 08/25/2017
<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 have ADDITIONAL INSURED provisions or be endorsed.
<br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on
<br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT
<br /> NAME:
<br /> Hub International Southeast PHONE 919 337-0000 FAX 866 553-5124
<br /> 4000 CentreGreen Way,Suite 140 (A/C,No,Ext):( ) (NC,No):( )
<br /> Cary, NC 27513 ADDRESS:
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURER A:Cincinnati Insurance Company 10677
<br /> INSURED INSURER B:Accident Fund General Insurance Company 12304
<br /> Child Care Services Association,Inc. INSURER C:
<br /> P 0 Box 901 INSURER D:
<br /> Chapel Hill,NC 27514
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 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 TYPE OF INSURANCE ADDL SUBR W POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD VD (MM/DD/YYYY) (MM/DD/YYYY)
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X OCCUR
<br /> X ETD 042 87 48 02/16/2017 02/16/2018 DAMAGE TO RENTED 5500 000
<br /> PREMISES(Ea occurrence) $
<br /> MED EXP(Any one person) $ 10,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000
<br /> PRO- 3,000,000
<br /> POLICY JECT LOC PRODUCTS-COMP/OP AGG $
<br /> OTHER: $
<br /> A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
<br /> (Ea accident)
<br /> ANY AUTO ETD 042 87 48 02/16/2017 02/16/2018 BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY(Per accident) $
<br /> X HIRED X NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY (Per accident) $
<br /> A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000
<br /> EXCESS LIAB CLAIMS-MADE ETD 042 87 48 02/16/2017 02/16/2018 AGGREGATE $ 3,000,000
<br /> DED X RETENTION$ 0 $
<br /> B WORKERS COMPENSATION X PER OTH-
<br /> AND EMPLOYERS'LIABILITY STATUTE ER
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WCV 8012045 02/16/2017 02/16/2018 E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBER EXCLUDED? N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> A Fidelity Bond ETD 042 87 48 02/16/2017 02/16/2018 Limit 500,000
<br /> A Sexual Abuse ETD 042 87 48 02/16/2017 02/16/2018 Limit 1,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Orange County Government is named as an additional insured with respect to the General Liability as required by written contract.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Orange County Government THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> 9 Y ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Attn: Risk Manager
<br /> PO Box 8181
<br /> Hillsborough,NC 27278 AUTHORIZED REPRESENTATIVE
<br /> P-(),
<br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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