DocuSign Envelope ID: A899BE5E- BAEC- 40F3 -9l E1- A9D77FC4C488
<br />ELCENTR -04 SPIKE
<br />'ACC]RU CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM /DD /YYYY)
<br />08/14/2018
<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 FAX
<br />(A/c, No, Ext): (919) 337 -0000 (A/c, No):(866) 553 -5124
<br />Hub International Carolinas
<br />E -MAIL
<br />ADDRESS:
<br />PHPK1802727
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />EACH OCCURRENCE
<br />INSURER A:Philadelphia Indemnity Insurance Company
<br />18058
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />INSURED
<br />INSURER B :
<br />MED EXP (Any one person)
<br />INSURER C :
<br />El Centro Hispano, Inc.
<br />INSURER D:
<br />$ 1,000,000
<br />600 East Main Street
<br />Durham, NC 27701
<br />INSURER E
<br />$ 2,000,000
<br />INSURER F:
<br />$ 2,000,000
<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 />IN SD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM DD
<br />POLICY EXP
<br />MM DD
<br />LIMBS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE F_X] OCCUR
<br />PHPK1802727
<br />04/06/2018
<br />04/06/2019
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />100,000
<br />MED EXP (Any one person)
<br />$ 5,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />X POLICY JERCOT F—] LOC
<br />OTHER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />PRODUCTS - COMP /OPAGG
<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 />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />•
<br />X
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />PHUB624430
<br />04/06/2018
<br />04/0612019
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />AGGREGATE
<br />$ 1,000,000
<br />DIED I X I RETENTION $ 10,000
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETOR/PARTNER/EXECU I IVE ❑
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />PER OTH-
<br />STATUTE I ER
<br />E.L. EACH ACCIDENT
<br />$
<br />E.L. DISEASE - EA EMPLOYEE
<br />$
<br />E.L. DISEASE - POLICY LIMIT
<br />•
<br />•
<br />Crime
<br />Professional Liabili
<br />PHPK1802727
<br />PHPK1802727
<br />04/06/2018
<br />04/06/2018
<br />04/06/2019
<br />04/06/2019
<br />Employee Dishonesty
<br />Each Incident
<br />120,000
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Professional Liab Aggregate $3,000,000
<br />Sexual or Physical Abuse or Molestation Vicarious Liability $1,000,000 per claim, $1,000,000 Aggregate
<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 Government
<br />9 Y
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />200 S Cameron St
<br />PO Box 8181
<br />AUTHORIZED REPRESENTATIVE
<br />Hillsborough, NC 27278
<br />ACORD 25 (2016/03) © 1988 -2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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