2017-513-E Finance - EmPOWERment, Inc. - Outside Agency Performance Agreement

Browse Search

DocuSign Envelope ID:72266CE5-DF5A-471 E-B671-CC65C8960691 �.-� EMPOINC-01 DMASON `4��° CERT FICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 07/18/2017 ll THIS CERTIFICATE IS ISSUED AS A MATT - OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY R NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANC, DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE + ERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an Al 11 DITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to th.111 terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the ce j ificate holder in lieu of such endorsement(s). PRODUCER [CONTACT Summers l NAME:----......._ ------ PHONE 100 Europa Drive Lowry,Inc. (A/C,No,Ext):(919)968-4472 aC,No):(919 9424221 P rY, Suite 571 I E-MAIL info STLinsure.com Chapel Hill,NC 27517-2393 INSURER(S)AFFORDING COVERAGE _._..................___ I NAIC# INSURER a_Technology Insurance Company Inc [42376 INSURED INSURER B: Empowerment,Inc. INSURER C: Delores Bailey 109 N.Graham St.#200 INSURER D Chapel Hill,NC 27516-2328 INSURER E: L uu INSURER F: , COVERAGES CERTIFICA II' NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF I 'ENT, LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIRE 'ENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAI THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIE'y.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR --- [ADDL,SUB, POLICY EFF POLICY EXP LTR TYPE OF INSURANCE !INSD I WV iu' POLICY NUMBER (MM/DD LIMITS /YYYYL(MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED X ', NPP1005089 06/16/2017 06/16/2018 PREMISES(Ea occurrences $.- MED EXP(Any one person). $ 10'000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY 1 PRO- F JECT L__J LOC PRODUCTS-COMP/OP AGG $ OTHER: Sex Abuse $ 1,000,000 AUTOMOBILE LIABILITY [ ' COMBINED SINGLE LIMIT 1,000,000 (E.daccident) $ ■ ANY AUTO _ NPP1005089 06/16/2017 06/16/2018 BODILY INJURYJPerperson_ $ OWNED SCHEDULED Ili AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ L X_ AUTOS ONLY _X....... AUTOS ONLY PROPERTY (Per accident) $ $ UMBRELLALIAB OCCUR I EACH OCCURRENCE $ XC RETENTION$ESSLIIA CLAIMS-MADE AGGREGATE $ E $ A WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER_ ANY PROPRIETOR/PARTNER/EXECUTIVE TWC3634138 06/16/2017 06/16/2018 E.L.EACH ACCIDENT J$ 500,000 OFFICER/MEMBER EXCLUDED? N/A ■ .....__.___ (Mandatory in NH) 500,000 DESCRIPTION OF OPERATIONS below _E.L.DI$EASE__EA EMPLOYEE $ DES RIPTION under ', !�I E.L.DISEASE-POLICY LIMIT $ 500'000 Prof Liability NPP1005089 06/16/2017 06/16/2018 Occurrence 1,000,000 I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACO 11,11.101,Additional Remarks Schedule,may be attached if more space Is required) UniFi Equipment Finance,Inc.and its assignors&assignees are additional insured as respects written contract.Contract Number 175024-0002;Xerox WorkCenre 7225 Trade up for Lease 175024-01 valu I d$18,015.15 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE UniFi Equipment Finance,Inc.ISAO'll ATIMA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. c/o American Lease Insurance 654 Amherst Road Sunderland,MA 01375 AUTHORIZED REPRESENTATIVE JJ ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The A lORD name and logo are registered marks of ACORD