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DocuSign Envelope ID: 378AF88F- OC7F- 43D2- BB6E- 43FBFE3C2605
<br />ARTSCEN -01
<br />DMASON
<br />,a►coRO CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMIDDIYYYY)
<br />05/14/2018
<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 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
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />CONTACT
<br />NAME:
<br />PHONE FAX
<br />(A /C, No, Ext): (919) 968 -4472 (A /C, No): (919) 942 -4221
<br />Summers Thompson Lowry, Inc.
<br />100 Europa Drive
<br />Suite 571
<br />ADDRESS: info @STLinsure.com
<br />Chapel Hill, NC 27517 -2393
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A: Great American Ins Co of NY
<br />$ 1,000,000
<br />INSURED
<br />INSURER B: Great American Alliance Ins Co
<br />INSURER C: FFVA Mutual Insurance Co
<br />$ 20,000
<br />The Arts Center Inc.
<br />INSURER D:
<br />PERSONAL & ADV INJURY
<br />300 G East Main Street
<br />Carrboro, NC 27510
<br />INSURER E
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY ❑ JECT PRO 1:1 LOC
<br />OTHER:
<br />INSURER F:
<br />$ 2,000,000
<br />PRODUCTS - COMP /OP AGG
<br />COVERAGES CERTIFICATE NUMBER: 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
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM /DD YYYY
<br />POLICY EXP
<br />MM DD YYYY
<br />LIMITS
<br />•
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE 541-1 OCCUR
<br />PAC4296967
<br />07/01/2017
<br />07/01/2018
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGETORENTED
<br />PREMISES Ea occurrence
<br />1,000,000
<br />$
<br />MED EXP (Any one person)
<br />$ 20,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY ❑ JECT PRO 1:1 LOC
<br />OTHER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />PRODUCTS - COMP /OP AGG
<br />$ 2,000,000
<br />$
<br />•
<br />AUTOMOBILE
<br />LIABILITY
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PAC4296967
<br />07/01/2017
<br />07101/2018
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />1,000,000
<br />$
<br />BODILY INJURY Per person)
<br />$
<br />BODILY INJURY Per accident
<br />$
<br />X
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />B
<br />X
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />UMB4296968
<br />07/01/2017
<br />07/01/2018
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />AGGREGATE
<br />$ 1,000,000
<br />DED X RETENTION $ 10,000
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y
<br />ANY PROPRIETOR /PARTNER/EXECU I IVE ❑
<br />OFFICER /MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />N/A
<br />WC8400032267
<br />01/01/2018
<br />01/01/2019
<br />PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 500,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 500,000
<br />E.L. DISEASE - POLICY LIMIT
<br />500,000
<br />$
<br />A
<br />General Liability
<br />PAC4296967
<br />07/01/2017
<br />07/01/2018
<br />Each Abuse
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />For Information Purposes
<br />CERTIFICATE HOLDER CANCELLATION
<br />ACORD 25 (2016/03) ©1988 -2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Orange Count Health Department
<br />9 Y p
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />300 W. Tryon Street
<br />Hillsborough, NC 27278
<br />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2016/03) ©1988 -2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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