2018-320-E County Mgr - Dispute Settlement Center training

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DocuSign Envelope ID: FA331D53- 1564- 4E84- 9D4F- EBF6D96B73CE s�C t�® CERTIFICATE OF LIABILITY INSURANCE DATE(MUMDIYYYY) CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 0 511 61201 8 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND 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 have ADDITIONAL INSURED provisions or 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 Diane Nadeau NAME Business Insurers of Carolinas PHONE Ext: N. 968 -4611 Nn : (919) 968 -8991 800 Eastowne Drive, Suite 208 1=40AIL dnadeau @businessAnsurers.com ADDRESS: PO Box 2536 EACH OCCURRENCE $ 1,000,000 INSURER(S) AFFORDING COVERAGE NAIC # Chapel Hill NC 27515 -2536 1111RERA: American Liberty Insurance Co 25186 INSURED Emplo e INSURER B : Employers Mutual Casualty 21415 DISPUTE SETTLEMENT CENTER INC INSURER C 302 W WEAVER ST STF A INSURER D : INSURER E: $ A CARRBORO NC 27510 -6004 INSURER F : 4W54487 UVV1zKAGtc5 CERTIFICATE NUMRERt L:LItS01bZZZ6b PF=VIQlnfd iW IUIZF17- 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 CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAYBE 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 ALIUL INSD WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MWDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ 1,000,000 DAMAGE TO PREMISES FR =n ce $ 300'000 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ A 4W54487 06/17/2018 06/17/2019 GEN'LAGGREGATE LlMITAPPLIES PER POLICY ❑ PECT_ ❑ LOC GENERAL AGGREGATE $ 2.000,000 PRODUCTS - COMPIOPAGO $ 2,000,000 Hirediborrowed $ 1,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea acciderrt $ BODILY INJURY (Per person) $ ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per aoc?dent $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION PER B AND EMPLOYERS LIABILITY D? ANY PROPRIETORIPARTNER(EXECUTIVE Y❑ OFFJCERfMEMBER EXCLUDE NIA 4H54487 06/17/2018 06/17/2019 STATUTE ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE -EA EMPLOYEE $ 100,000 (Mandatory in NH) If yes, describe under ❑ ESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY UM1T $ 500'000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES {ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Orange County Government PO Box 8181 Hillsborough NC 27278 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 Oc 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD