2018-443-E Finance - EmPowerment outside agency agreement

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DocuSign Envelope ID: 557E0BA8 -0FDF- 4943 -B1 OE- 6AB96D651 1`413 ^1 EMPOI N C -0'1 DMAS ,acc3►era CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 0612512018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED) BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsoment(s), PRODUCER NAM E• _ Summers Thompson Lowry, Inc. 100 Europa Drive (A"erecAN1, Eadj: (918) 86I3y4d72 Uyc. Ncy.(918) "942^4227 Suite 571ooaa ss: Ino @STLInSure.Gom - Chapel Hill, NC 27517 -2393 D18URERI$I AFFORDING COVERAGE NAN: INSURED Empowerment, Inc. Delores Bailey 109 N. Graham St. #200 Chapel Hill, NC 27516 -2328 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT„ TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN BY PAID CLAIMS. INSR ADDL SUER POLICY EFF POLICY EXP L LTR TYPE OF INSURANCE POLICY NUMBER 001YYYY1 _ LIMITS A )( COMMERCIAL GENERAL LIABILITY CLAIMS MATE I " 1 OCCUR x AUTHORIZED REEPRESENTA71VE NPPI005089 EACH OCCURRENCE 0611612018 0611612019. Pa $E$ Ea D $ 1,000,000 $ i MED EXP {Any one person- $ 10,000 _ PERSONAL & AOV INJURY $ 1,fl0O,00D _ GEN'L AGGREGATE TE LIMIT APPLIES PER: $ 3.000,000 GENERAL. AGGREGATE POLICY F7 jR II LOC PRODUOTS- COMPIOPAGG OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT BODILY INJURY (Per son $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS 1 BODILY INJURY Peracc6dettiA $ PROPERTY DAMAGE Par acc danSl . _ N yy p AUTO��p S ONLY At 01 'M UMBRELLA LIM OCCUR EACH OCCURRENCE AGGREGATE $ EXCESS LIAB CLAIMS-MADE DED j RETENTION $ B WORKERS COMPENSATN]N AND EMPLOYERS' LIABILrrY ANY PROPRIETOWPARTNERIEXECUTWE Y �j�FICCERIMEMBER EXCLUDED? IMendmory In NHj NIA ITW1;3715D15 0611612018 ]( I PER OT - STATUTE ER 06116/2019 EACH. ACCIDENT _ --� E.L. DISEASE - EA EMPLOYEE 500,1000 $_ -- 0,�00 S If yyes, describe under DESCRIPTION OF OPERATIONS below f , E.L.. DISEASE - POLICY LIMIT Soo ,aoo $ A General Liability INPP1005089 06/1612018 05/1512019 Occurrent 1,000,000 DESCRIPTION OF OPERATIONS? LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mars space is requtrad) Certificate Holder is additional Insured as respects written contract. CERTIFICATE HOLDER CANCELLATION ACORD 25 (2015103) ©1988 -2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County Government g Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 81811 Hillsborough, NC 272.78 AUTHORIZED REEPRESENTA71VE ACORD 25 (2015103) ©1988 -2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD