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DocuSign Envelope ID: EBOFBDBE -FD15- 4428- 899B- 19A867F94OCC OP ID: LP
<br />CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY)
<br />05/0212018
<br />THIS CERTIFICATE I5 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 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 endorsement(s).
<br />PRODUCER
<br />INSR
<br />4A'AE ' Jeff Rubish
<br />NAME:
<br />High & Rubish Insurance Agency
<br />ORANGE COUNTY
<br />PHONE 919 -�� -1144 FAX N.1; 919. 913 -1154
<br />P.O. Box 3040
<br />6415 Farrington Rd. Ste 141
<br />Ph I �Y EXP
<br />c 4 Ext -
<br />E-MAIL natalie@highandrubish.com
<br />Chapel Hill, NC 27517
<br />Jeffrey A. Rubish
<br />A
<br />PRODUCER
<br />r E D ,OCIM --1
<br />ECP0349072
<br />INSURERS AFFORDING COVERAGE
<br />NAIC 9
<br />INSURED Orange Congregations In
<br />$ 2,000,00
<br />$ 2,00{x,00
<br />$ 10,00
<br />INSURER A: Cincinnati Insurance Company
<br />10677
<br />Missions, Inc.
<br />$ 2,000,00
<br />INSURER B ; Hartford Underwriters Ins.
<br />30104
<br />300 Millstone Drive
<br />$ 4,000,00
<br />GENT AGGREGATE LIMITAPPLIES PER
<br />X POLICY PRO LOC
<br />PRODUCTS - COMP/OP AGG
<br />Hillsborough, NC 27278
<br />INSURER C: -
<br />A
<br />AUTOMOBILE LIABILITY
<br />ANY AUTO
<br />ALL OWNED AUTOS
<br />SCHEDULED AUTOS
<br />X HIRED AUTOS
<br />X NON -OWNED AUTOS
<br />- --
<br />EBA0349072
<br />I
<br />14N512415
<br />INSURER D:
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />$ 2,000,00
<br />$
<br />$
<br />$
<br />$
<br />BODILY INJURY (Per person)
<br />INSURER E :
<br />PROPERTY DAMAGE
<br />(PER ACCIDENT)
<br />INSURER F:
<br />r•_nv�an[_F -c Cr-RTIFICATF NIIMRER!
<br />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 />TYPE OF INSURANCE
<br />X
<br />ORANGE COUNTY
<br />POLICY NUMBER
<br />INM1RbY E Y�
<br />Ph I �Y EXP
<br />LIMITS
<br />AUTHORIZED REPRESENTATIVE
<br />+ `r
<br />A
<br />GENERAL LIABILITY
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS-MADE a OCCUR
<br />ECP0349072
<br />1011512075
<br />I4i1�Si21 }7$
<br />EACH OCCURRENCE
<br />$ 2,000,00
<br />$ 2,00{x,00
<br />$ 10,00
<br />DAMAGE MFRI!��
<br />PREMISES (Ea xwrrence
<br />MED EXP (Any one person)
<br />PERSONAL B ADV INJURY
<br />$ 2,000,00
<br />GENERAL AGGREGATE
<br />$ 4,000,00
<br />GENT AGGREGATE LIMITAPPLIES PER
<br />X POLICY PRO LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 4,000,00
<br />$
<br />A
<br />AUTOMOBILE LIABILITY
<br />ANY AUTO
<br />ALL OWNED AUTOS
<br />SCHEDULED AUTOS
<br />X HIRED AUTOS
<br />X NON -OWNED AUTOS
<br />EBA0349072
<br />I
<br />14N512415
<br />1011512018
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />$ 2,000,00
<br />$
<br />$
<br />$
<br />$
<br />BODILY INJURY (Per person)
<br />BODILY INJURY (Per accident)
<br />PROPERTY DAMAGE
<br />(PER ACCIDENT)
<br />$
<br />UMBRELLA LIAR
<br />EXCESS LIAR
<br />OCCUR
<br />CLAIMS -MADE.
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE.
<br />$
<br />DEDUCTIBLE
<br />RETENTION $
<br />$
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNEWEXECUTIVE YIN
<br />OFFICERIMEMBER EXCLUDED? �I
<br />(Mandatory In NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />22WECBV6360
<br />08/18/2017 08/1812018
<br />X 4VC STATU- TH-
<br />E L. EACH ACCIDENT
<br />$ 100,00
<br />E.L. DISEASE -EA EMPLOYEE
<br />$ 100,00
<br />El- DISEASE LIMIT
<br />504 00
<br />$ r
<br />A
<br />Sexual Misconduct
<br />'ECP0349072 05/0212018 10/15/2018
<br />Occurence 1,000,00
<br />Aggregate 1,000,00
<br />DESCRIPTION OF OPERATIONS LOCATIONS! VEHICLES Attach ACORD 101, Addltionai Remarks Schedule, if more space Is required)
<br />Additional Insured Status Applies to Holder
<br />r- coTrrlr -ATr_ ury nGO CANCELLATION
<br />ORANG -1
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />ORANGE COUNTY
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />P O Box 8181
<br />302 W. Tryon St..
<br />Hillsborough, NC 27278
<br />AUTHORIZED REPRESENTATIVE
<br />+ `r
<br />(P 1988 -2009 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD
<br />
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