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DocuSign Envelope ID: C5305795- 2DF5- 4A04- BO90- 9F458AA520CB
<br />�1 CHARHOU -01 DMASON
<br />,4c'c�ieu CEV IVICATE OF LIABILITY INSURANCE DATE(MMIODNYYY)
<br />06/04/2018
<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 polleies 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 CONTACT
<br />NAME;
<br />Summers Thompson Lowry, Inc.
<br />100 Europa Drive (AICD,NN , Ext): (919) 968 - 447,2 (AAIC, No) :(919) 942 -4221
<br />Suite 571 ADDRESS: info@STLinsure.com
<br />Chapel Hill, NC 27517 -2393 �A r
<br />INSURERISi AFFORDING COVERAGE
<br />INSURED
<br />Charles House Association
<br />Paul Klever
<br />7511 Sunrise Road
<br />Chapel Hill, NC 27514
<br />_ INSURER_ A: Philadelphia Ins Co
<br />INSURER B: Carolina Mutual Insurance Inc.
<br />INSURER C :
<br />INSURER D:
<br />INSURER E: _
<br />INSURER F
<br />!'nllnn A (]CC rMorlrirA rc Au IRaM=D- RF%flglr)hl Kit IMRI=P.
<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 ADDL SUFIR POLICY EFF POLICY EXP
<br />LTR TYPE OF INSURANCE IN p p POLICY NUM9ER MlOD1YYY LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />AUTHORIZED REPRESENTATIVE
<br />X1,,1 R 5 .�„ w 5
<br />EACH OCCURRENCE
<br />3 1,000,000
<br />CLAIMS -MADE X OCCUR
<br />X
<br />PHPK1791330
<br />05/10/2018
<br />05/10/2019
<br />DAMAGE TO RENTED
<br />REMISES Ea oce urcence
<br />100000
<br />$ 5,000
<br />MED EXP (Any one personj
<br />PERSONAL BADVINJURY
<br />$ 1,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />$. 3,000,000
<br />_
<br />GENT
<br />GENERAL AGGREGATE
<br />$ 3,000,000.
<br />POLICY El v6of [A LOC
<br />PRODUCTS - COMPIOPAGG
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE LIABILITY
<br />T. Me
<br />Ea accident
<br />1,000,000
<br />$
<br />BODILY INJURY Per erson)
<br />$
<br />ANY AUTO
<br />PHPI<1791330
<br />05/1012018
<br />05/1012019
<br />BODILY INJURY Per acCidepk).
<br />$
<br />OWNED - SCHEDULED
<br />AUTOS ONLY AUTOS
<br />P accRd Y DAMAGE
<br />$
<br />X AUTOS ONLY X NON-OWNED
<br />A
<br />x
<br />uMBRELLA LIAR
<br />X OCCUR
<br />EACH OCCURRENCE
<br />5 1,000,000
<br />AGGREGATE
<br />EXCESSLIA13
<br />CLAIMS -MADE
<br />PHUB621294
<br />0511012018
<br />0511012019
<br />OED I X RETENTION$ 10,000
<br />Comp Ops
<br />$ 1,000,000
<br />B
<br />WORKERS COMPENSATION
<br />AND
<br />AND EMPLOYERS LIABILITY
<br />ANY PROPR €ETORIPARTNERIEXECUTIVE YIN
<br />DFFIC ERfMEMBER EXCLUDED?
<br />[Mandatory in NH)
<br />N 1 A
<br />WC19056 -2017
<br />06/25/2018
<br />0612512019
<br />X ST TUTE OTHER -
<br />E.L. EACH ACCIDENT-
<br />_
<br />500,000
<br />E.L. DISEASE - EA EMPLOYE
<br />_5
<br />500, 000
<br />S
<br />E.L. DISEASE - POLICY HMIT
<br />500,000
<br />$
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />A
<br />Molestation/Sexual
<br />PHPK1791330
<br />05/10/2018
<br />0511012019
<br />Aggregate
<br />1,000,000
<br />A
<br />MolestationlSexuai
<br />PHPK1791330
<br />05/1012018
<br />05/10/2019
<br />Occurrence
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mare space Is required)
<br />Orange County Government is listed as Additional Insured with respect General Liability
<br />^ A err 1 - e'A41!`CI I Arin AI
<br />ACORD 25 (2016103) c0 1988 -2015 ACORO CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks Of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Orange Count Government
<br />g y
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />PO Box 8181
<br />Hillsborough, NC 27278
<br />AUTHORIZED REPRESENTATIVE
<br />X1,,1 R 5 .�„ w 5
<br />ACORD 25 (2016103) c0 1988 -2015 ACORO CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks Of ACORD
<br />
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