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DocuSign Envelope ID:2A83AE93-E43A-4DCA-8002-FADD789204A6
<br /> ACORL) CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
<br /> 4110■, 10/17/2016
<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 NAMEACT Debbie Callahan
<br /> Moore and Johnson Agency PHONE 919-582-1977 FAX 919-719-8806
<br /> 3809 Computer Drive (A/C,No,Ext): (NC,No):
<br /> Raleigh NC 27609 ADDRESS:dcallahan @mooreandjohnson.com
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURER A:Berkshire Hathaway
<br /> INSURED BIGBR-1 INSURERB:SUmmit Holdings
<br /> Big Brothers Big Sisters of the INSURER C:
<br /> Triangle, Inc.
<br /> 808 Aviation Pkwy Ste 900 INSURER D:
<br /> Morrisville NC 27560 INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:884394368 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 POLICY EFF POLICY EXP W /Y LIMITS
<br /> LTR INSD VD POLICY NUMBER (MM/DDYYY) (MM/DD/YYYY)
<br /> A x COMMERCIAL GENERAL LIABILITY 47-SPK-255375-01 9/28/2016 9/28/2017 EACH OCCURRENCE $1,000,000
<br /> CLAIMS-MADE X OCCUR
<br /> DAMAGE TO RENTED
<br /> PREMISES(
<br /> SES(Ea occurrence) $1,000,000
<br /> X Employee Benefit MED EXP(Any one person) $20,000
<br /> X D&O Liability PERSONAL&ADV INJURY $1,000,000
<br /> GE 'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $3,000,000
<br /> POLICY PRO-
<br /> JECT LOC PRODUCTS-COMP/OP AGG $3,000,000
<br /> OTHER: Empl.Benefits $1,000,000
<br /> A AUTOMOBILE LIABILITY 47-RWS-255376-01 9/28/2016 9/28/2017 COMBINED SINGLE LIMIT $
<br /> (Ea accident) 1,000,000
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS AUTOS
<br /> X HIRED AUTOS )( NON-OWNED PROPERTY DAMAGE
<br /> AUTOS (Per accident)
<br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $
<br /> DED RETENTION$ $
<br /> B WORKERS COMPENSATION 0521063508 9/8/2016 9/8/2017 X PER OTH-
<br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE 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
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> A Property 47-SPK-255375-01 9/28/2016 9/28/2017 Blkt BPP $200,000
<br /> Crime Fidelity $100,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Professional Liability #47-SPK-255375-01 9/28/16 to 9/28/17 Limits
<br /> $1, 000, 000/$3,000,000 Aggregate
<br /> Abuse and Molestation $1,000,00 Each Incident/ $1, 000, 000 Aggregate
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Orange County Government Finance&Admin Services THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> PO Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Hillsborough NC 27278
<br /> AUTHORIZED REPRESENTATIVE
<br /> ©1988-2014 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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