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DocuSign Envelope ID:380F50AD-C98D-426B-80DC-9Al34EB8DA24 TIDES <br /> V IIGIIITr• J 1 <br /> DATE(MM/DD/YYYY) <br /> ACORDTM CERTIFICATE OF LIABILITY INSURANCE 7/24/2017 <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 NAME:ACT <br /> Felicia McAroy <br /> Marsh & McLennan Agency LLC PHONEo FAX <br /> (A/C <br /> Ext:925 482-9300 A/C,No): 925 482-9390 <br /> Marsh & McLennan Ins Agncy LLC E-MAIL SS, felicia.mcaroy@barneyandbarney.com <br /> 1340 Treat Blvd#250 Lic OH18131 INSURER(S)AFFORDING COVERAGE NAIC# <br /> Walnut Creek,CA 94597 INSURER A:Philadelphia Insurance Company 18058 <br /> INSURED INSURER B: <br /> Tides Center <br /> INSURER C: <br /> CHCYF,#1112 <br /> INSURER D <br /> P.O. Box 29198 <br /> San Francisco,CA 94129 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 CONTRACTOR 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS <br /> LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ <br /> CLAIMS-MADE OCCUR PREMISESOEa ocicur ence $ <br /> MED EXP(Any one person) $ <br /> PERSONAL&ADV INJURY $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ <br /> PRO LOC <br /> PRODUCTS-COMP/OP AGG $ <br /> POLICY JECT <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> Ea accident <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS PRO <br /> PER DAMAGE $ <br /> NON-OWNED Per accident <br /> HIRED AUTOS AUTOS <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DIED I I RETENTION$ $ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY Y/N TAT TE I E <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? N/A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> A Blanket Business PHPK1583250 12/01/2016 12/01/201 $721,329 Limit <br /> Personal Property $5000 Deductible <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Project: Chapel Hill -Carrboro Youth Forward,#1112. <br /> CERTIFICATE HOLDER CANCELLATION <br /> Orange Count Government SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> g y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Attn: Allen Coleman ACCORDANCE WITH THE POLICY PROVISIONS. <br /> P.O. Box 8181 <br /> Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE <br /> ©1988-2014 ACORD CORPORATION.All rights reserved. <br /> ACORD 25(2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD <br /> #S1331701/M1019836 MANN <br />