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DocuSign Envelope ID: 17COF518- 9238 - 480E- 96E6- 77F FCC C2626B <br />`JU 121, 2014 6: JOAM IV o, 7401 P. 2 <br />Client#: 955852 04SE:NIOCARI <br />ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE B lnnlnna (MMIDDIYYYY) <br />nco <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 W5UING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) Enust have ADDITIONAL INSURED provlBlons or be andorsed. <br />If SUBROGATION IS WAIVED, Subject to the tarty and conditions of the policy, certain pallciac may require an endorsemont. A statelrlsnt on <br />this certificate does not confer any rights to the certificate holder in lieu of SUCK ondorsalnant(r). <br />PROOVOrmR <br />p�}7AC7 <br />McGrlff Insurance Services <br />RONE <br />� E I; BSB 743y2217 VC yQ: $0198278861 <br />494 Galllmore Dairy Road <br />E-MA <br />Suite F <br />ADORES <br />MEDEXP (Any otie ve A <br />sS 00D <br />Greensboro, NC 27409 <br />INSORER(G) AFFORDING COVERAGE <br />HAIC I <br />INSURER A; CvR" *fin Imurerwe CampanY <br />35378 <br />INSURED Orange <br />Senior Dare of range County Inc <br />B., llarlwllnrurancn Ccmpnny <br />38970 <br />PERSONAL L ADV INJURY <br />$1,000,1500 <br />Attn nay Health Center <br />INSURER C: - <br />105 Meadowlands Dr <br />INSURER O: <br />s3000000 <br />INSURERS: <br />Hillsborough, NC 27278 -8181 <br />NOVRrR r. <br />PRODUCTS - COMPIOPAGG <br />GL]VLxAGES CERTIFICATE. PJIIMRF.R! OVIAM KI ►inaanea, <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN I$SUEP TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION CIF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDeo BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS Or $UGH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />LIR TYPE DP INSURANCE INSR UT POLICY NUMBER MMIDDMYYF MM1OtMO BXP LIMITS <br />A <br />2t <br />COMMLRCIALGENERA LIABILITY <br />XI CLAIhrB -MADE CJCCUR <br />x <br />SM921051 <br />7113/2018 <br />071131201 <br />rAACCHp�OCTCUR�RENCE <br />$1000000 <br />PREFAISE3 II.ET nce <br />450,0 0 <br />7t <br />MEDEXP (Any otie ve A <br />sS 00D <br />BI1PD Ded.5,000 <br />PERSONAL L ADV INJURY <br />$1,000,1500 <br />GEN'LAGGREOATE41MI1 APPLIES PER: . <br />PRO - <br />POLICY D &01 F-1 LOC <br />s3000000 <br />GENEPALAGGArQATsz <br />PRODUCTS - COMPIOPAGG <br />t <br />_ <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />CoMew -e N LE umrr <br />Es -- ,1 -desil <br />BODILY INJURY (Per p4f59h) <br />1 <br />ANY AUTO <br />OW�EED BCHEDULED <br />AUT 1 ONLY AUTOS <br />HtREU NON -OWNED <br />AUTOS ORLY AUTOS ONLY <br />BODILY IN IURY Per aGCfdenl <br />( j <br />PEIOPERTY DAMAGfi <br />e e <br /># <br />1,1101IR"LA61AD <br />OCCUR <br />EACi4=URR'FNCE <br /># <br />E XCESS LIAB <br />CLAIM'�MADE <br />ADORE ©AYE <br />$ - <br />aFD I I RU W-ON s <br />S <br />B <br />WORKERRSCOMPrKAYMN <br />AND EMPLOYERS'LIABILITY YIN <br />ANYPROPRIETOMPARTNERIEXECUTNE�r-y-�� <br />OFFICERIMEMBER EXCLUDED? i r l <br />NIA <br />MWC010010202 <br />2148/2099 <br />021001201S <br />pEft orH- <br />E.L. EACH ACCIDENT <br />$500 000 <br />_ <br />r.L. DISEASE -E0. EMPLOYEE <br />$600,000 <br />(MpndatoryInNH) <br />If yy5 @, dowoe Uno4u <br />OE9CRIPTIONOFOPERATiONSbe164 <br />E.L,DISWr;- POLICYLIMIY' <br />- �-- - <br />$500,000 <br />A <br />Professional <br />SM921059 <br />0711312018 <br />071IT20119 <br />$1,000,000 each clalm <br />Liability <br />$3,+000,000 aggregate <br />$5,000 died. <br />DMSCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ArVRO 107, Addlllunel Renaults ashodulo, mey he attached Y nlarc aparo is requiradl <br />Policy Includes endorsement that provides Additional Insured status for any Landlord, ownor, or Properly <br />Manager- of the Designated Premises or any Tradeshow or Convention Sponsor or Operator or any Lessor of <br />equipment. <br />Professional Liability - POLO SM921051 <br />(See Attached Descriptions) <br />anon, 1r1U^1 e <br />Orange County GlDvarnrnont <br />200 S Cameron Street <br />Hillgbwough, NC 2727E <br />ACORD 25 (2016103) 1 of 2 <br />#S204711011M20467370 <br />SHOULD ANY OF THE ABOVE DE°SCRISErb POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE VVILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS, <br />AUTHORIZED REPRESENTATIVE <br />@ 1988 -2015 ACOkD CORPORATION. All rights reservers, <br />The ACORD name and logo are roglaterad marks of ACORD <br />L1111MA: <br />