2017-480-E Finance - Freedom House Recovery Center, Inc. - Outside Agency Performance Agreement

Browse Search

DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB AC CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) �••�' 7/10/2017 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 NAME: Crystal Ireland Business Insurers of Carolinas PHONE (919)968-4611 FAX (919)968-8991 (AfC.No.Ext): (A/C,No): 800 Eastowne Drive, Suite 208 EMAIL ADDRESS:cireland @business-insurers.com PO Box 2536 INSURER(S)AFFORDING COVERAGE NAIC# Chapel Hill NC 27515-2536 INsuRERARiverport- Berkley National Ins Co INSURED INSURER B:United Wisconsin Insurance Company 29157 Freedom House Recovery Center, Inc INSURERC: 104 New Stateside Drive INSURERD: INSURER E: Chapel hill NC 27516 INSURERF: 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 ADD,SUBR POLICY EFF POLICY EXP POLICY NUMBER ,JMM/DD/YYYY)_(MM/DD/YYYYL LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE _ $ 1,000,000_ DAMAGE TO RENTED A III ,CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 1,000,000 nProfessional Liability X 8527338-10 7/1/2017 7/1/2018 MEDEXP(Anyoneperson) $ 20,000 Sexual & Physical Abuse PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 Ell PRO POLICY JEI 1- 1 LOC PRODUCTS-COMP/OPAGG $ 3,000,000 OTHER: $ - AUTOMOBILE LIABILITY O aBINEDtSINGLE LIMIT $ 1,000,000 A X ANY AUTO 1 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 accident) Medicalpayments $ 5,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESSLIAB 1 CLAIMS-MADE AGGREGATE $ 1,000,000 DED (RETENTIONS 18527338-10 7/1/2017 v 7/1/2018 , $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N X STATUTE X ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ S00,000 B (Mandatory in EXCLUDED? Y N/A 0400158723 5/16/2017 5/16/2018 ( ) E.L.DISEASE-EA EMPLOYEE $ 500,000 DESs,RIPTIOeunder E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below A Employee Dishonesty 8527338-10 7/1/2017 7/1/2018 LIMIT 25,000 DESCRIPTION OF OPERATIONS/LOCATIONS 1 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 PO Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS. 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 INS025(2614011