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DocuSign Envelope ID: E7784BE7- 82AF- 4AF1- AA11- 944D2300E7BD
<br />Client #: 929075
<br />20CHAPEHIL3
<br />ACORD,,, CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM /DD /YYYY)
<br />07/24/2018
<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 any rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />McGriff Insurance Services, Inc.
<br />Post Office Box 13941
<br />Durham, NC 27709
<br />919 281 -4500
<br />CONTACT
<br />NAME: Beth Wilkerson
<br />PHONE 919 281 -4500 FAX 888 746 -8761
<br />Lo Ext : AIC, No
<br />-MA
<br />ADDRESS: bcwilkerson @mcgrifflnsurance.com
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC#
<br />INSURER A: Philadelphia Indemnity Insurance Co.
<br />O
<br />1 $058 8
<br />INSURED
<br />Chapel Hill Training Outreach Pil Inc
<br />800 Eastowne Dr Ste 105
<br />INSURER B : Progressive Southeastern In—noe Co.
<br />38784
<br />INSURER C Ac.identFtmd In. C.OfAmerica
<br />10166
<br />$1,000,000
<br />Chapel Hill, NC 27514
<br />INSURER D:
<br />INSURER E :
<br />INSURER F:
<br />PREMISES Ea occurrence)
<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
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />X
<br />PHPK1774361
<br />2/05/2018
<br />02105/201
<br />EACH OCCURRENCE
<br />$1,000,000
<br />CLAIMS -MADE [X OCCUR
<br />PREMISES Ea occurrence)
<br />$1,000,000
<br />MED EXP (Any one person)
<br />$20,000
<br />PERSONAL & ADV INJURY
<br />$1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 3,000,000
<br />PRO-
<br />POLICYFI JECT F7 LOC
<br />PRODUCTS - COMP /OP AGG
<br />$ 3,000,000
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />065151020
<br />2/05/2018
<br />02/05/201
<br />Ea accideD SINGLE LIMIT
<br />$2,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />OWNED X SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />A
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />PHUB617091
<br />02/05/2018
<br />02/05/2019
<br />EACH OCCURRENCE
<br />$1,000,000
<br />AGGREGATE
<br />$1,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED X RETENTION $10000
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N
<br />OFFICERIMEMBER EXCLUDED? I NI
<br />NIA
<br />WCV6096247
<br />12/17/2017
<br />121171201
<br />X PER OTH-
<br />STATUTE IER
<br />E.L. EACH ACCIDENT
<br />$500 OOO
<br />E.L. DISEASE - EA EMPLOYEE
<br />$500 OOO
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$500,000
<br />A
<br />Professional Liab
<br />PHPK1774361
<br />2/05/2018
<br />02/05/201
<br />$1,000,0001$3,000,000
<br />A
<br />Cyber Liability
<br />PHSD1319124
<br />02/05/2018
<br />02/05/201
<br />$1,000,000/$2,000,000
<br />A
<br />Abuse /Molestation
<br />PHPK1774361
<br />02/05/2018102/05/201
<br />$1,000,000/$3,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />** Workers Comp Information **
<br />Other States Coverage
<br />Certificate Holder is included as Additional Insured, per written contract, as their interest may appear
<br />I.CK 1 Ir ILA 1 t nULUtr(
<br />Orange County Government
<br />Finance & Admin Services
<br />Attn: Allen Coleman
<br />200 S Cameron St; PO Box 8181
<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 />ne TPIRR -2015 ACORD CORPORATION. All rights reserved
<br />ACORD 25 (2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD
<br />#S20688104/M20687965 BG3
<br />
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