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CHARHOU -01
<br />DMASON
<br />T
<br />.a►coRCa° CERTIFICATE OF LIABILITY INSURANCE
<br />14�
<br />DATE (MN9DDIYYYY)
<br />0610412018
<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 />Summers Thompson Lowry, Inc.
<br />100 Europa Drive
<br />Suite 571
<br />CONTACT NAME:
<br />PH
<br />lac, ONE No, Est): (919) 968 -4472 FAX Ne):(919) 94.2_ -4221
<br />a DRIESS, info @STLinsure.com
<br />Chapel Hill, NC 27517 -2393
<br />INSURERS AFFORDING COVERAGE
<br />NAIL q
<br />INSURERA:Philadelphia Ins Co
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />INSURED
<br />INSURER B: Carolina Mutual Insurance Inc.
<br />100,000
<br />$
<br />INSURER C:
<br />MED EXP (Any one person)
<br />Charles House Association
<br />Paul Klever
<br />"
<br />7511 Sunrise Road
<br />INSURER D:
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY j �T LOG
<br />OTHER:
<br />INSURERE:
<br />$ 3,000'000
<br />Chapel Hill, NC 27514
<br />INSURER F :
<br />CYTVFRAOFS CFRTIFICATF MIIMRFP- RFVISION NIIMRFR-
<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 CONTRACTOR OTHER DOCUMENTWITH RESPECTTO 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 />L
<br />TYPE OFINSORANCE
<br />ADOLSUBR
<br />p
<br />p
<br />POLICY NUMBER
<br />POLICY EFF
<br />DD fYYY`(I
<br />POLICY EXP
<br />IMMUDDIYYYYJ
<br />LIMITS
<br />A
<br />X
<br />COMMERCMLGENERALLIABILITY
<br />CLAIMS -MADE X OCCUR
<br />X
<br />PHPK1791330
<br />05/10/2018
<br />05/1012019
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO RENTED
<br />PREMISES Ea occumence)
<br />100,000
<br />$
<br />MED EXP (Any one person)
<br />$ 6,000
<br />PERSONAL B AOV INJURY
<br />$ 1,000'000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY j �T LOG
<br />OTHER:
<br />GENERALAGGREGATE
<br />$ 3,000'000
<br />PRODUCTS- COMP /OP ADS
<br />$ 3,000,000
<br />•
<br />AUTOMOBILE LIABILITY
<br />ANY AUTO
<br />AUTOS SCHEDULED AUTOSWUL�ED
<br />X AUTOS ONLY X ALL SONLY
<br />PHPK1791330
<br />05/10/2018
<br />0511012019
<br />COMBINED SINGLE LIMIT
<br />,_(Ea accident
<br />1,000,000
<br />$
<br />BODILY INJURY Per person)
<br />$
<br />BODILY INJURY Per accident)$
<br />Peramiden DAMAGE
<br />$
<br />•
<br />X
<br />UMBRELLALIAB
<br />EXCESS LIAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />PHUB621294
<br />05/10/2018
<br />OSM012019
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />AGGREGATE
<br />$
<br />DED I X I RETENTION$ 10,000
<br />comp OpS
<br />11000,000
<br />•
<br />WORKERS COMPENSATION
<br />ANY EMPLOYERS' LIABILITY
<br />ANVCERIMEETORIPARTNERIEXECUrIVE YIN
<br />O (Mandatory NHI EXCLUDEDT
<br />(MantlatOry in NHH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />WC19056 -2017
<br />06/26/2018
<br />06/25/2019
<br />X STATUTE OATH -
<br />E.L. EACH ACCIDENT
<br />$ 500,000
<br />E.L. DISEASE -EA EMPLOYE
<br />$ 500'000
<br />E.L. DISEASE - POLICY LIMIT
<br />500,000
<br />$
<br />•
<br />A
<br />Molestation /Sexual
<br />MolestationlSexual
<br />PHPK1791330
<br />PHPK1791330
<br />05/1012018
<br />05/1012018
<br />05/10/2019
<br />05110/2019
<br />Aggregate
<br />Occurrence
<br />1,000,000
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule,may be allached if more space is required)
<br />Orange. County Government is listed as Additional Insured with respect General Liability
<br />Orange County Government
<br />PO Box 8181
<br />Hillsborough, NC 27278
<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 />(,
<br />-+Wary 1) 5„„„„„A, 5
<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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