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DocuSign Envelope ID: CC5DDEFF- F35B- 45F1- AD01- 4586504D8AF6 <br />COMMEMP -01 <br />VDECAMP <br />' iIII ° CERTIFICATE OF LIABILITY INSURANCE <br />�� <br />DATE 08 /01 /2018 ) <br />08/01 /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 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 />CONTACT <br />NAME: <br />PHONE 968 -4472 FAX 942 -4221 <br />(A/C, No, Ext): ( 919 ) (A/c, No):( 919 ) <br />Summers Thompson Lowry, Inc. <br />100 Europa Drive <br />Suite 571 <br />ADDREss: Vicky @STLinsure.com <br />Chapel Hill, NC 27517 -2393 <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSURER A: United State Liability Ins. <br />25895 <br />INSURED <br />INSURER B:AmTrust Insurance Company of Kansas Inc. <br />INSURER C: <br />$ 5,000 <br />Community Empowerment Fund <br />INSURER D: <br />PERSONAL & ADV INJURY <br />208 N. Columbia Street, Suite 100 <br />Chapel Hill, NC 27514 <br />INSURER E <br />AGGREGATE LIMIT APPLIES PER: <br />POLICY PRO- F7 LOC <br />JECT <br />OTHER: <br />INSURER F: <br />$ 2,000,000 <br />PRODUCTS - COMP /OP AGG <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 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 />LTR <br />TYPE OF INSURANCE <br />ADDL <br />INSD <br />SUBR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />M DD YYY <br />POLICY EXP <br />MM DD YY <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE � OCCUR <br />[trt11 p I � su^ r,A, 5 <br />NPP1580143 <br />01/26/2018 <br />01/26/2019 <br />EACH OCCURRENCE <br />$ 1,000,000 <br />PREMISES Ea occurrence <br />PREMISES <br />100,000 <br />$ <br />MED EXP (Any one person) <br />$ 5,000 <br />PERSONAL & ADV INJURY <br />$ 1,000,000 <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER: <br />POLICY PRO- F7 LOC <br />JECT <br />OTHER: <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />PRODUCTS - COMP /OP AGG <br />$ 2,000,000 <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$ <br />BODILY INJURY Per person) <br />$ <br />BODILY INJURY Per accident <br />$ <br />Per OaccitlenDAMAGE <br />$ <br />UMBRELLA LIAB <br />EXCESS LIAB <br />OCCUR <br />CLAIMS -MADE <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />DIED RETENTION $ <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />YIN <br />ANY PROP RIETOR /P/EXECUTIVE ❑ <br />OFFICER /MEMBER EXCLUDED? <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />KWC1141466 <br />08/11/2018 <br />08/11/2019 <br />PER OTH- <br />STATUTE ER <br />E.L. EACH ACCIDENT <br />500,000 <br />$ <br />E.L. DISEASE - EA EMPLOYEE <br />$ 500,000 <br />E.L. DISEASE - POLICY LIMIT <br />5500,000 <br />• <br />• <br />General Liability <br />General Liability <br />NPP1580143 <br />NPP1580143 <br />01/26/2018 <br />01/26/2018 <br />01/26/2019 <br />01/26/2019 <br />Sexual Abuse Occ. <br />Sexual Abuse Agg. <br />1,000,000 <br />2,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />Informational Purposes Only <br />CERTIFICATE HOLDER CANCELLATION <br />ACORD 25 (2016/03) ©1988 -2015 ACORD 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 <br />9 y <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />200 S. Cameron Street <br />Hillsborough, NC 27278 <br />AUTHORIZED REPRESENTATIVE <br />[trt11 p I � su^ r,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 />