Orange County NC Website
DocuSign Envelope ID: 70B14FB4 -AE32- 4116- 89EE- 5DA48DF2569C <br />ACC>R" CERTIFICATE OF LIABILITY INSURANCE <br />4`- � <br />DATE(MM,DDIYYYY) <br />1 07105/2018 <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 be endorsed. It SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder In lieu of such endorsement(s). <br />PRODUCER <br />NAME' Louise Churchill <br />Herring & Bickers Insurance Agency <br />PHONE A, No: (919)479 -1868 <br />2344 Operations Drive <br />DRESS: _ <br />INSURER(S) AFFORDING COVERAGE <br />NAfC N <br />Suite 101 <br />INSURER A : Hartford <br />00914 <br />Durham NC 27705 <br />INSURED <br />i NSU RER 8 : <br />CLAIMS-MADE ® OCCUR <br />INSURER C : <br />Chapel Hill institute of Cultural & Language <br />INSURER D: <br />109 Conner Dr Ste 2200 <br />INSURER E: <br />$ 1000000 <br />1 INSURER F <br />$ 10000 <br />Chapel Hill NC 27514 <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, TERN) 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 />lam <br />WVD <br />POLICY NUMBER <br />POLICY ErF <br />MfWDDlYYYY <br />POLICY XP <br />M[W'DD.YYYY <br />LIMITS <br />X <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1000000 <br />CLAIMS-MADE ® OCCUR <br />PREMISES a occurrence <br />$ 1000000 <br />ME EXP (Anyone person) <br />$ 10000 <br />PERSONAL BADVINJURY <br />$ 1000000 <br />A <br />N <br />N <br />22SBAUL5464 <br />01101/2018 <br />01/01/2019 <br />LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$ 2000000 <br />�GEE'N'LAGGREGATE <br />f1 POLICY PRO- <br />JECT 7 LOC <br />PRODUCTS - COMP{OPAGG <br />$ 2000000 - - <br />OTHER: <br />AUTOMOBILE LIABILITY <br />COMBINEDSINGLE LIMIT <br />Ea acc danl <br />$ 100 ©000 <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />A <br />ALL DVJNEO SCHEDULED <br />AUTOS AUTOS <br />N <br />N <br />22SBAUL5464 <br />01101/2018 <br />0110112019 <br />BODILY INJURY Peraccidenl) <br />$ <br />PR11 PERTYDAMAGE <br />Cps, accident <br />x HIRED AUTOS Ix NON -OVMED <br />AUTOS <br />$ <br />UMBRELLA LIAR <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAR <br />CLAIMS -MADE <br />DED RETENTION § <br />$ <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY <br />OFFICERIMEEM$ R EXCLUDED? ECUTIVE Y� <br />(Mandatary in NH) <br />N t A <br />N <br />22WBCCS1989 <br />0110112018 <br />0110112013 <br />PER OTH- <br />STATUTE ER <br />E.L EACH ACCIDENT <br />$ 500000 <br />E. L. DISEASE -EA EMPLOYEE <br />$ 500000 <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$ 500000 <br />E &O <br />$250,000 each / $250,000 aggregate <br />A <br />N <br />N <br />SP1563629 <br />07101/2018 <br />07101/2019 <br />$2,500 deductible <br />DESCRIPTION OF OPERATI DNS f LOCATIONS r VEHICLES (ACORD 1D1. Additional Remarks Schedule, may be attached if more space Is required) <br />CERTIFICATE HOLDER CANCELLATION <br />Orange County Department of Human Rights and Relations <br />200 South Cameron St <br />Hillsborough <br />AX ". lnlMr-AA wiry <br />ACORD 25 (2014101 ) <br />NC 27278 <br />m waloWneMnrn nnorrn rnfvnr nnr <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />a <br />0 1988 -2014 ACORD CORPORATION. All ricrhts reserved <br />The ACORD name and logo are registered marks of ACORD <br />