2017-557-E Finance - OE Enterprises, Inc. - Outside Agency Performance Agreement

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DocuSign Envelope ID:6D821DAO-CO6F-4D38-BB4F-DB28CB54AD8E a DATE(MM/DDNYYY) A��>J CERTIFICATE OF LIABILITY INSURANCE 7/11/2017 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 Tammy Brown Jennings Bryan-Chappell Insurance Services ( oNN,Ext): (336)227-7458 FAX (336)343-1000 PO Box 1118 ■ooRess:tammyb@ jbcins.com INSURER(S)AFFORDING COVERAGE NAIC# Burlington NC 27216 INSURERA:Philadelphia Indeminity Ins. Co. 18058 INSURED INSURER B Accident Fund General Insurance OE Enterprises, Inc. INSURER C: 348 Elizabeth Brady Road INSURERD: INSURER E: Hillsborough NC 27278 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1762903121 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100,000 A CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ PHPK1677966 6/30/2017 6/30/2018 MED EXP(Any one person) $ 5,000 PERSONAL&ADVINJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO- JECT LOC PRODUCTS-COMP/OPAGG $ 2,000000 OTHER: - AUTOMOBILE LIABILITY COMBINED tSINGLE LIMIT $ 1,000,000 (Ea X ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED SCHEDULED AUTOS AUTOS PHPK1677966 6/30/2017 6/30/2018 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ X AUTOS X AUTOS .(Per accident)Medical payments $ 5,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 4,000,000 A EXCESS LIAB X CLAIMS-MADE AGGREGATE $ 4,000,000 DED X RETENTION$ 10,000 PHUB591253 6/30/2017 6/30/2018 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 N/A OFFICER/MEMBER EXCLUDED? B (Mandatory in NH) 2000017714 7/1/2017 7/1/2018 E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ i 500,000 A Professional Liability PHPK1677966 6/30/2017 6/30/2018 1,000,000 2,000,000 A Sexual Abuse / Molestation PHPK1677966 6/30/2017 6/30/2018 1,000,000 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION tcomar @orangecountync.gov SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County Government THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Tammy Comar P.O. Box 8181 Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE Tammy Brown/TB t;:t0A-ry /L,- i- ot.-'ce," -' ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025mum