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DocuSign Envelope ID:7B55B196-3912-4C1A-ADB4-A753058DFEFD
<br /> ARCOF-4 OP ID: KB
<br /> ,a►cosz° CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
<br /> 164. � 1 06121/2017
<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 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 CONTACT Kendra A Biddle,CPCU,CIC
<br /> Marsh&McLennan Agency-CLT P HONE Fax
<br /> 440 South Church St.,Ste 500 A/c No, arc,No):336-841-5319
<br /> Charlotte,NC 28202 ADDRESS:kbiddle @senndunn.com
<br /> M.Bryan Beasley,CIC
<br /> INSURER(S)AFFORDING COVERAGE NAIC A
<br /> INSURER A:Key Risk Insurance Company
<br /> INSURED The Arc of the Triangle,Inc. INSURER B:Selective Insurance Co of Amer 12572
<br /> 1709 Legion Road,Suite 100
<br /> Chapel Hill, INC 27517 INSURER C:
<br /> INSURER D:
<br /> INSURER E:
<br /> INSURER F:
<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 TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS
<br /> LTR IN POLICY NUMBER MM/DD/YYYY MMIDDIYYYY
<br /> B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00
<br /> TO RENTED
<br /> CLAIMS-MADE Al OCCUR 52258874 07/01/2017 07/01/2018 PREMISES Ea occurrence $ 1,000,00
<br /> MED EXP(Any one person) $ 20,000
<br /> PERSONAL&ADV INJURY $ 1,000,00
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,00
<br /> POLICY 1-1 PRO-
<br /> JECT F—] LOC PRODUCTS-COMP/OP AGG $ 3,000,00
<br /> OTHER: $
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
<br /> Ea accident
<br /> B ANY AUTO 52258874 07101/2017 07/0112018 BODILY INJURY(Per person) $
<br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS AUTOS
<br /> X X NON-OWNED PROPERTY DAMAGE $
<br /> HIRED AUTOS AUTOS Per accident
<br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00
<br /> B EXCESS LIAB CLAIMS-MADE S2258874 07/01/2017 07/01/2018 AGGREGATE $ 1,000,00
<br /> DED I X I RETENTION$ 0 $
<br /> WORKERS COMPENSATION X IR
<br /> AND EMPLOYERS'LIABILITY STATUTE PER E ER
<br /> A ANY PROPRIETOR/PARTNER/EXECUTIVE YIN KEY0137206 07/04/2017 07/04/2018 E.L.EACH ACCIDENT $ 500,00
<br /> OFFICERIMEMBER EXCLUDED? ❑N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 500,00
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ 500,00
<br /> B Professional S2258874 07/0112017 07/01/2018 Incident 1,000,00
<br /> Liability Aggregate 3,000,00
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> ORANGI8
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Orange County Government ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Finance&Administrative Sery
<br /> 200 S Cameron Street AUTHORIZED REPRESENTATIVE
<br /> PO Box 8181 ` 1� a
<br /> Hillsborough, NC 27278
<br /> ©1988-2014 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
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