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DocuSign Envelope ID: BD79FOFD- 23DB- 49E6- BF04- 154CBFDC5BB8
<br />'ACaRL7� CERTIFICATE OF LIABILITY INSURANCE
<br />PDA7TE(MM /DD/YYYY)
<br />07/03/2018
<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 Tammy Brown
<br />NAME:
<br />Jennings Bryan - Chappell Insurance Services
<br />AICONN. Ext : (336) 227 -7458 ac No): (336) 343 -1000
<br />E -MAIL tammyb @jbcins.com
<br />ADDRESS:
<br />PO Box 1118
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />INSURERA: Philadelphia Indeminity Ins. Co.
<br />18058
<br />Burlington NC 27216
<br />INSURED
<br />INSURER B: Accident Fund General Insurance Company
<br />12304
<br />INSURER C :
<br />OE Enterprises, Inc.
<br />INSURER D:
<br />348 Elizabeth Brady Road
<br />INSURER E:
<br />$ 100,000
<br />INSURER F:
<br />$ 5,000
<br />Hillsborough NC 27278
<br />COVERAGES CERTIFICATE NUMBER: CL187303754 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 />INSD
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM /DD /YYYY
<br />POLICY EXP
<br />MM /DD /YYYY
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE OCCUR
<br />DAMAGE
<br />,REM SESOEa oicc E.Dence
<br />$ 100,000
<br />MED EXP (Anv one person)
<br />$ 5,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />A
<br />PHPK1845734
<br />06/30/2018
<br />06/30/2019
<br />GEN'LAGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />PRO -
<br />X POLICY PRO ❑ LOC
<br />PRODUCTS - COMP /OPAGG
<br />$ 2,000,000
<br />Employee Benefits
<br />$ 1,000,000
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />ANYAUTO
<br />A
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />PHPK1845734
<br />06/30/2018
<br />06/30/2019
<br />BODILY INJURY (Per accident)
<br />$
<br />X
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED �/ NON -OWNED
<br />AUTOS ONLY /� AUTOS ONLY
<br />Medical payments
<br />$ 5,000
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 4,000,000
<br />AGGREGATE
<br />$ 4,000,000
<br />A
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />PHUB637164
<br />06/30/2018
<br />06/30/2019
<br />DED I X RETENTION $ 10,000
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETOR /PARTNER/EXECUTIVE
<br />OFFICER /MEMBER EXCLUDED?
<br />( Mandatory in NH)
<br />NIA
<br />2000021234
<br />07/01/2018
<br />07/01/2019
<br />PER OTH-
<br />STATUTE X ER
<br />E.L. EACH ACCIDENT
<br />500,000
<br />$
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 500,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />500,000
<br />$
<br />A
<br />Professional Liability
<br />Sexual Abuse /Molestation
<br />7PHSD1361369
<br />06/30/2018
<br />06/30/2019
<br />$1,000,000
<br />$1,000,000
<br />$2,000,000
<br />$2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />CERTIFICATE HOLDER CANCELLATION
<br />@ 1988 -2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Orange County Government
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />P.O. Box 8181
<br />AUTHORIZED REPRESENTATIVE
<br />Hillsborough NC 27278
<br />(�
<br />@ 1988 -2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />
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