2018-102-E County Mgr - Dispute Settlement Center OCPEH Conflict Training Spring 2018

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DocuSign Envelope ID: A9C88E8B- 0482- 4A2A- BFB5- 5B11348EB17E7 ACC? " CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD /YYYY) 8/9/2017 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 Kelley OSo NAME: Y FvCNE. Ext: (919) 968 -4611 FAX No: (919) 968 -8991 Business Insurers of Carolinas E -MAIL ADDRESS: kloso @business- insurers.com 800 Eastowne Drive, Suite 208 INSURER(S) AFFORDING COVERAGE NAIC# PO Box 2536 INSURER A:Hamil ton Mutual Insurance Co 14125 Chapel Hill NC 27515 -2536 INSURED INSURER B :Em to ers Mutual Casualty 21415 INSURER C: DISPUTE SETTLEMENT CENTER INC INSURER D: 302 W WEAVER ST STE A INSURER E: $ 300,000 INSURER F: $ 5,000 CARRBORO NC 27510 -6004 COVERAGES CERTIFICATE NUMBER:17 /18 WC,Bop 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM DDY/YYYY EXP /YYYY MM/ DY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE FXI OCCUR DA AGE To RETED PRE M ISES Ea occurrence $ 300,000 MED EXP (Any one person) $ 5,000 4W54487 6/17/2017 6/17/2018 PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO- JECT F7 LOC X PRODUCTS - COMP /OP AGG $ 2 , 000 , 000 Hired /Borrowed $ 1, 000 , 000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N X PER OTH- STATUTE 7 1 ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 100,000 B OFFICER /MEMBER EXCLUDED? (Mandatory in NH) N/A 4H54487 6/17/2017 6/17/2018 E.L. DISEASE - EA EMPLOYE $ 100,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION jethompson @orangecountync. Orange County PO Box 8181 Hillsborough, NC 27278 ACORD 25 (2014/01) INSn25rgmami SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE lley Loso /KELLL ° L ©1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD