Orange County NC Website
DocuSign Envelope ID: 74839431- 9216- 429F- BFA4- 2AC6473BD9D3 <br />�•�•``•� CERTIFICATE OF LIABILITY INSURANCE <br />GATE (MM/DDIYYYY) <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( i09) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain Policies may require an endorsement. A Statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsee nt(a ). <br />PRODUCER <br />Business Insurers of Carolinas <br />800 Eastowne Drive, Suite 208 <br />PO Box 2536 <br />Chapel hill NC 27515 -2536 <br />INSURED <br />Pathways to Change <br />960 Corporate Drive <br />Suite 408 <br />Hillsborough NC 27278 <br />NAhIE: L Amber Curiae <br />PHONE (919) 968 -4611 FAx <br />{A(g, Ma. Eat};_ . —(A/C , "y (919) 968 -8991 <br />E-MAIL <br />ADDRESS; acurlee[ business— insurers . com <br />INSURERS) AFFORDING COVE RAGE NAIC # <br />IINSURER AAmerican Casualty Company of 20427 <br />INSURERB:Lloyda of London 00432 <br />INSURER C: <br />i <br />INSLIRER D: <br />NSURER E <br />�uvtrc�,C�a =S CERTIFICATE NUMBER,CL1761918902— - <br />REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTEO 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 />TR ADDLSUER., . <br />-TR : TYPE OF INSURANCE POI_ €CY NUMBER POLICY EFF POLICY EXP <br />XCOMMERCIALG£NERAL LIASILITY MMI❑ YYYY IDDfYYYY LIMITS <br />(:ACH OCCURRENCE S 1,004,000 <br />p+ CLANS-MADE OCCUR DAMAGE TO RENTED <br />i <br />GEN'L AGGREGATE LIMIT APPLIES PER <br />x PRO- <br />POLICY <br />— „ JECT LOC <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS �_ y AUTOS <br />HIRED AUTOS NON -OWNED <br />-- AUTOS <br />X 6021140912 <br />UMBRELLA LIAR OCCUR <br />EXCESS LIAR CLAIMS-MADE <br />DED RETNTK)NS <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANY ?ROF+31E:'CRIPARTNERIEMECUTiVE <br />OFr''CE.R1VF,MI3FR EXCLUDED? NIA <br />(Mandatory in NH) <br />If yes desclihe url.dw <br />13 FrOf6s$lcinal Liability 14PL148440017 <br />7/1/2017 7/1/2018 <br />PREMISES;E3cim mrcej S <br />ME EXP "Any one perwni S <br />PERSONAL d ADV INJURY S <br />GENERAL AGCREGATF S <br />PRODUCTS - COMP,"OP AGO S <br />BAIL S <br />C N D S—IN i E LINII S <br />BODILY INJURY spur per@CNt; S <br />BODILY INJURY ,Par awoenli S <br />PROPERTY DAMAGE S <br />;Per a=dent, <br />S <br />EACH OCCURRENCE 5 <br />AGGREGATE, S <br />S <br />E L EACH ACCIOENI S <br />E.L. DISEASE - EA EMPLOYEE, $ <br />E L. DISEASE -POLICY LIMIT S <br />8/29/2017 9/25/2019 LIMIT <br />AGGREGATE <br />DESCRIPTION OF OPERATIONS I LOCATIONS r VEHICLES (ACORD 141, Additional Remarks Schedule, may be attached if more space is required) <br />Orange County is an additional insured with respect to general liability per written contract. <br />CERTIFICATE HOLDER <br />CANCELLATION <br />900,000 <br />10,000 <br />1,000,000 <br />2,000,000 <br />2,000,000 <br />1,D00 <br />1,000,000 <br />1,000,000 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 9E CANCELLED BEFORE <br />Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />200 S. Cameron Street ACCORDANCE WITH THE POLICY PROVISIONS. <br />PO Box 8161 <br />Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE <br />Amber Cur Yee /AMBER <br />1988 -2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />INS025 2� .W7 <br />