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I <br /> DocuSign Envelope ID:7F6941BA-A8EF-47E6-80D8-B1F7F90D3351 <br /> ..41,G7C)02%Cr DATE(MM/DD/YYYY) <br /> 4.......-- CERTIFICATE OF LIABILITY INSURANCE 12/31/2016 <br /> THIS CERTIFICATEIS 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 this <br /> certificate does not confer rights to the certificate holder in lieu of such endorsement( }. <br /> PHMUCER CONTACT <br /> Nme <br /> BB&T INSURANCE SERVICES INC/PHS PHONE <br /> Ex(); (866) 467-8730 (A/FAX <br /> C.Noj (888) 443-6112 <br /> 272545 B: (866) 467-8730 F: (888) 443-6112—; <br /> F-1.1ADRIL..s,,„ <br /> PO BOX 29611 INEURER(S)AFFORDING COVERAGE NAICe <br /> CHARLOTTE NC 28229 INSURER A: f.i ell tj.1101. Ins Co LTD <br /> INSURED INSURER B: <br /> INSURER C <br /> CODIMUNITY EMPOWERMENT FUND . muilmo: <br /> 208 N COLUMBIA ST STE 100 INSURER E: =I <br /> CHAPEL HILL NC 27514 INSURERS <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BEI_OW 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 <br /> TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> TYPE OF INSURAAICE ADDL WM <br /> MS'R FM) Poticr NUMBER POLICY EN. <br /> _4.At/p.D/Y111) POLICY.EA7? <br /> IMAI/DIVYYD:1 LIAITTS <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 52, 000, 000 <br /> I CLAIMS-MADE I X I OCCUR DAMAGE TO RENTED .$1, 000, 000 <br /> PREMISES(Ea occurrence) <br /> X General Liab 22 SEE EN9653 0:112b/2017 01726/2018 MED EXP(Any one person) $10, 000 <br /> PERSONAL&ADV INJURY :2, 000, 000 <br /> GENERAL AGGREGATE <br /> ;4, 000, 000 <br /> GENE AGGREGATE LIMIT APPLIES PER: <br /> IPOLICY L_1 jex-_,_ <br /> X1 LOC PRODUCTS-COMP/OP AGG z,4, 000, 000 <br /> OTHER: $ <br /> COMBINED SINGLE LIMIT <br /> :.AUTOOMWONBEIDLE LIABILITY 2, 000, 000 <br /> (Ea accident) <br /> IIIANY AUTO BODILY INJURY(Per person) <br /> 22 SEE ON 9653 01/26/2017 02/26/201.8 BODILY INJURY Per accident) $ <br /> AUTOS ONLY _I ASCUFTioEsDULED <br /> HIRED x 1NON-OWNED <br /> I [ <br /> PROPERTY DAMAGE <br /> — : <br /> AUTOS ONLY ___,. AUTOS ONLY (Per accident) <br /> . UMBRELLA LIAB OCCUR EACH OCCURRENCE <br /> . EXCESS LIAB CLAIMS-MADE AGGREGATE <br /> ---___ <br /> s <br /> 0 IIII RETENTION$ <br /> • --- — <br /> km 'idLER,s—COMPENSA:ION <br /> AND EMPIOYERS'LLASRE7 <br /> ANY PROPRIETORJPARTNER/E.XECUTIVEY/N <br /> OFFICER/MEMBER EXCLUDED? <br /> OPERATIONS below N/A PER <br /> STATUTE <br /> I <br /> E.L.EACH ACCIDENT I-7- s <br /> (uMeasncdatRowryTii:NNI-01F) E.L.DISEASE EA EMPLOYEE "I <br /> If es.desclibe under <br /> yes. <br /> ET DISEASE-POLICY LIMIT <br /> DESCRIPTION OF OPERA DONS/LOCATIONS/VEHIGIAGORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Those usual to the IhshreWs Operations. <br /> CERTIFICATE HOLDER CANCELLATION „.„.„. <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED <br /> BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE <br /> Orange County DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. <br /> PC Box 8181 AUTHORIZED REPRESENTATIVE <br /> 200 S CAMERON ST -767-7" - <br /> HILLSBOROUGH, NC 27278 <br /> ©1988-2015 ACORD CORPORATION.All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br /> ......... ...1 <br />