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CERTIFICATE.OF.LIABILITY.INSURANCE DATE (MM/DD/YYYY) <br />9/26/2017 <br />THIS CERTIFICATEIS 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 />REPRESENTATIVEORPRODUCER, AND THECERTIFICATEHOLDER. <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 this <br />certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER CONTACT <br />NAME: <br />INSURANCE NOODLE LLC/PHS PHONE <br />(A/C, No, Ext):(866) 467-8730 FAX <br />(A/C, No):(888) 443-6112 <br />551718 P:(866) 467-8730 F:(888) 443-6112 E-MAIL <br />ADDRESS: <br />PO BOX 29611 INSURER(S) AFFORDING COVERAGENAIC# <br />CHARLOTTE NC 28229 INSURER A :Hartford Casualty Ins Co 29424 <br />INSURED INSURER B : <br />INSURER C : <br />ROCCHETTI AND ASSOCIATES INC INSURER D : <br />10204 HALLBERG LN INSURER E : <br />RALEIGH NC 27614 INSURER F : <br />COVERAGESCERTIFICATE NUMBER:REVISION NUMBER: <br />THISISTOCERTIFYTHATTHEPOLICIESOFINSURANCELISTEDBELOWHAVEBEENISSUEDTOTHEINSUREDNAMEDABOVEFORTHEPOLICYPERIOD <br />INDICATED.NOTWITHSTANDINGANYREQUIREMENT,TERMORCONDITIONOFANYCONTRACTOROTHERDOCUMENTWITHRESPECTTOWHICHTHIS <br />CERTIFICATEMAYBEISSUEDORMAYPERTAIN,THEINSURANCEAFFORDEDBYTHEPOLICIESDESCRIBEDHEREINISSUBJECTTOALLTHE <br />TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR TYPE OF INSURANCE ADDL <br />INSR <br />SUBR <br />WVD POLICY NUMBER POLICY EFF <br />(MM/DD/YYYY) <br />POLICY EXP <br />(MM/DD/YYYY)LIMITS <br />COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE $1,000,000 <br />CLAIMS-MADE X OCCUR <br />83 SBM TL0404 <br />DAMAGE TO RENTED <br />PREMISES (Ea occurrence)$300,000 <br />A X General Liab 04/19/201704/19/2018 MED EXP (Any one person)$10,000 <br />PERSONAL & ADV INJURY $1,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $2,000,000 <br />POLICY PRO- <br />JECT X LOC PRODUCTS - COMP/OP AGG $2,000,000 <br />OTHER:$ <br />AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br />(Ea accident)$ <br />ANY AUTO BODILY INJURY (Per person)$ <br />OWNED <br />AUTOS ONLY <br />SCHEDULED <br />AUTOS BODILY INJURY (Per accident)$ <br />HIRED <br />AUTOS ONLY <br />NON-OWNED <br />AUTOS ONLY <br />PROPERTY DAMAGE <br />(Per accident)$ <br />$ <br />UMBRELLA LIAB OCCUR EACHOCCURRENCE $ <br />EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br />DEDRETENTION $$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />N/ A <br />PER <br />STATUTE <br />OTH- <br />ER <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH) <br />Y/N E.L. EACH ACCIDENT $ <br />E.L. DISEASE- EA EMPLOYEE $ <br />Ifyes, describe under <br />DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />Those usual to the Insured's Operations. <br />CERTIFICATE HOLDERCANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED <br />BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE <br />DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. <br />ORANGE COUNTY HEALTH DEPARTMENT <br />300 W TRYON ST <br />HILLSBOROUGH, NC 27278 <br />AUTHORIZED REPRESENTATIVE <br />© 1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD <br />DocuSign Envelope ID: 52FB3400-CB52-4D46-9231-157F153B491B