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DocuSign Envelope ID: 1640431D- 872F- 4BC9- ACA1- 2226D9788920
<br />ORANCOU -04
<br />VDECAMP
<br />DATE (MMIDIIIYYYY) CERTIFICATE OF LIABILITY INSURANCE 01122/20/8
<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 poiicy(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 />Chapel Hill, NC 27517 -2393
<br />CONAME: NTACT
<br />PHONE FAx
<br />(A /C, No, Ext): (919) 968 -4472 i�c, Np);(919) 942 -4221
<br />Eap IES : Vicky @STLinsure.com
<br />A
<br />X
<br />COMMERCIALGENERALLIABILITY
<br />CLAIMS -MADE rK OCCUR
<br />INSURERS AFFORDING COVERAGE
<br />NAIC N
<br />INSURER A : Alliance for Non - Profits for Insurance Risk Retention Group
<br />0811012017
<br />08/10/2018
<br />INSURED
<br />INSURER B: Hartford Underwriting Insurance Com an
<br />30104
<br />Orange County Partnership for
<br />Young Children
<br />INSURER C: Carolina Casualty Insurance
<br />MED EXP (Ary one person)
<br />S 20,000
<br />120 Providence Rd Ste 101
<br />INSURER D:
<br />INSURER E
<br />Chapel Hill, NC 27514
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: RFVISInN NI IMRFR-
<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 />TR
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />M D Y
<br />P041CY EXP
<br />M YYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIALGENERALLIABILITY
<br />CLAIMS -MADE rK OCCUR
<br />201736915
<br />0811012017
<br />08/10/2018
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE STO REoNT`ED n
<br />$ 500,000
<br />MED EXP (Ary one person)
<br />S 20,000
<br />PERSONAL & ADV INJURY
<br />$ 1'000'000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY 0 JeT r_1 LOC
<br />GENERAL AGGREGATE
<br />$ 3'000,000
<br />PRODUCTS - COMPIOPAGG
<br />$ 3'000,000
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />COMaBINED SINGLE LIMIT
<br />11000,000
<br />BODILY INJURY Per person)$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />201736915
<br />08/1012017
<br />0811012018
<br />BODILY INJURY Per accident
<br />S
<br />X
<br />PROPERTY DAMAGE
<br />Per aeeitlenl
<br />$
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />A
<br />X
<br />UMBRELLA LIAB
<br />MX
<br />OCCUR
<br />EACH OCCURRENCE
<br />S 1,000,000
<br />AGGREGATE
<br />$ 1'000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />201736915UMB
<br />08110/2017
<br />08!1012018
<br />DED X I RETENTION$ 10,000
<br />B
<br />WORMERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNERIEXECUTIVE YIN
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />22WECIT8297
<br />10101!2017
<br />10!0112018
<br />y( IPER 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 />C
<br />D &OIEPLI
<br />1574022
<br />0811012017
<br />08/10/2018
<br />D &0IEPLI
<br />1,000,000
<br />A
<br />Liquor Liability
<br />201736915
<br />08110/2017
<br />08110/2018
<br />Sexaul Abuse Agg.
<br />2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
<br />Fidelity Coverage
<br />Policy No. 0105987727LB; Policy Term: 08130!2016 to 2019
<br />$100,000 Limit of Liability, $1,000 Deductible
<br />Sexual Conduct and Physical Abuse Coverage
<br />Policy No. E02017- 36915; Policy Term: 08 -10 -17 to 08 -10.18
<br />$2,000,000 Aggregate!$ 1,000, 000 Each Claim
<br />SEE ATTACHED ACORD 101
<br />Orange County
<br />200 S. Cameron Street
<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 />AUTHOR2ED REPRESENTATIVE
<br />-91„1, 1 R s
<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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