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DocuSign Envelope ID: 42882613- 58E8 -4BA1- 9376- A348D7FC56CA
<br />20BOYSGIR2
<br />ACORDTM CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM /DD/YYYY)
<br />7/25/2018
<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. If 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 />BB &T Insurance Services, Inc.
<br />Post Office Box 13941
<br />CONTACT NAME: Terrie G. Roberts
<br />PHONE 919 281 -4500 FAX 8887468761
<br />A/C, No, Ext : A/C ): , No
<br />E -MAIL
<br />ADDRESS: t g roberts bbandt.com
<br />Durham, NC 27709
<br />919 281 -4500
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC#
<br />INSURER A: United States Flre Insurance Co
<br />21113
<br />INSURED
<br />Boys & Girls Club of Durham & Orange
<br />Counties
<br />INSURER B • North River Insurance Company
<br />.
<br />21105
<br />INSURER G
<br />MED EXP (Any one person)
<br />$10,000
<br />PO Box 446
<br />INSURER D:
<br />PERSONAL & ADV INJURY
<br />$1,000,000
<br />GEN'L
<br />Durham, INC 27702 -0446
<br />INSURER E:
<br />$3,000,000
<br />INSURER F :
<br />PRODUCTS - COMP /OPAGG
<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, TERM OR CONDITION OF ANY CONTRACTOR 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 />ADDL
<br />INSR
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM /DD /YYYY
<br />POLICY EXP
<br />MM /DD /YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE � OCCUR
<br />13736884
<br />9/09/2017
<br />09/09/2018
<br />EACH OCCURRENCE
<br />$1,000,000
<br />PREMISES Ea RENTED
<br />$100,000
<br />MED EXP (Any one person)
<br />$10,000
<br />PERSONAL & ADV INJURY
<br />$1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY FI JECT LOC
<br />OTHER:
<br />GENERAL AGGREGATE
<br />$3,000,000
<br />PRODUCTS - COMP /OPAGG
<br />$3,000,000
<br />$
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />HIRED AUTOS X NON -OWNED
<br />AUTOS
<br />13736884.
<br />13736886
<br />09/09/2017
<br />09/09/201
<br />MBINED
<br />Ea a.,d.n SINGLE LIMIT
<br />$1,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />BODILY INJURY (Per accident)
<br />$
<br />X
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />A
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />OCCUR
<br />CLAIMS -MADE
<br />9/09/2017
<br />09/09/2018
<br />EACH OCCURRENCE
<br />$1,000,000
<br />X(
<br />X
<br />AGGREGATE
<br />$1,000,000
<br />DED RETENTION $
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR /PARTNER/EXECUTIVE YIN N
<br />OFFICER/MEMBER EXCLUDED? �
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />N/A
<br />13736890
<br />09/09/2017
<br />09/09/2018
<br />X STATUTE EORH
<br />E.L. EACH ACCIDENT
<br />$500 OOO
<br />E.L. DISEASE - EA EMPLOYEE
<br />$500,000
<br />E.L. DISEASE - POLICY LIMIT
<br />$500,000
<br />B
<br />A
<br />A
<br />Directors & Offic
<br />Prof. Liab.
<br />Abuse
<br />13736891
<br />13736884
<br />13736884
<br />09/09/2017
<br />09/09/2017
<br />09/09/2017
<br />09/09/2018
<br />09/09/2018
<br />09/09/2018
<br />1,000,000/2,000,000
<br />1,000,000/2,000,000
<br />1,000,000/2,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />l0fai's I l a Pfd\ IIRE F. PJ A NJ Q! §LWY111 \Pf q AA \II NJ0
<br />Orange County Government
<br />Finance & Administrative Services
<br />200 South 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 />AUTHORIZED REPRESENTATIVE
<br />t7 1'48R -2014 ACORD CORPORATION_ All rights reserved
<br />ACORD 25 (2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD
<br />#S20696122/M18738760 MEBAR
<br />
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