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DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE <br />THISCERTIFICATEISISSUEDASAMATTEROFINFORMATIONONLYANDCONFERSNORIGHTSUPONTHECERTIFICATEHOLDER.THIS <br />CERTIFICATEDOESNOTAFFIRMATIVELYORNEGATIVELYAMEND,EXTENDORALTERTHECOVERAGEAFFORDEDBYTHEPOLICIES <br />BELOW.THISCERTIFICATEOFINSURANCEDOESNOTCONSTITUTEACONTRACTBETWEENTHEISSUINGINSURER(S),AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT:IfthecertificateholderisanADDITIONALINSURED,thepolicy(ies)mustbeendorsed.IfSUBROGATIONISWAIVED,subjectto <br />thetermsandconditionsofthepolicy,certainpoliciesmayrequireanendorsement.Astatementonthiscertificatedoesnotconferrightstothe <br />certificate holder in lieu of such endorsement(s). <br />CONTACTPRODUCERNAME: <br />FAXPHONE <br />(A/C, No):(A/C, No, Ext): <br />E-MAIL <br />ADDRESS: <br />PRODUCER <br />CUSTOMER ID #: <br />INSURER(S) AFFORDING COVERAGENAIC # <br />INSURED INSURER A : <br />INSURER B : <br />INSURER C : <br />INSURER D : <br />INSURER E : <br />INSURER F : <br />COVERAGESCERTIFICATE NUMBER:REVISION NUMBER: <br />THISISTOCERTIFYTHATTHEPOLICIESOFINSURANCELISTEDBELOWHAVEBEENISSUEDTOTHEINSUREDNAMEDABOVEFORTHEPOLICYPERIOD <br />INDICATED.NOTWITHSTANDINGANYREQUIREMENT,TERMORCONDITIONOFANYCONTRACTOROTHERDOCUMENTWITHRESPECTTOWHICHTHIS <br />CERTIFICATEMAYBEISSUEDORMAYPERTAIN,THEINSURANCEAFFORDEDBYTHEPOLICIESDESCRIBEDHEREINISSUBJECTTOALLTHETERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />ADDLSUBRINSR POLICY EFFPOLICY EXPTYPE OF INSURANCE LIMITSPOLICY NUMBERLTR (MM/DD/YYYY)(MM/DD/YYYY)INSRWVD <br />GENERAL LIABILITY EACH OCCURRENCE$ <br />DAMAGE TO RENTED <br />COMMERCIAL GENERAL LIABILITY $PREMISES (Ea occurrence) <br />CLAIMS-MADEOCCUR MED EXP (Any one person)$ <br />PERSONAL & ADV INJURY$ <br />GENERAL AGGREGATE$ <br />GEN'L AGGREGATE LIMIT APPLIES PER:PRODUCTS - COMP/OP AGG$ <br />PRO-$POLICYLOCJECT <br />COMBINED SINGLE LIMITAUTOMOBILE LIABILITY $(Ea accident) <br />ANY AUTO BODILY INJURY (Per person)$ <br />ALL OWNED AUTOS BODILY INJURY (Per accident)$ <br />SCHEDULED AUTOS PROPERTY DAMAGE $(PER ACCIDENT)HIRED AUTOS <br />$NON-OWNED AUTOS <br />$ <br />UMBRELLA LIAB EACH OCCURRENCE$OCCUR <br />EXCESS LIAB CLAIMS-MADE AGGREGATE$ <br />$DEDUCTIBLE <br />$RETENTION$ <br />WC STATU-OTH-WORKERS COMPENSATION <br />TORY LIMITSERAND EMPLOYERS' LIABILITY Y / N <br />ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT$N / AOFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH)E.L. DISEASE - EA EMPLOYEE$ <br />If yes, describe under <br />E.L. DISEASE - POLICY LIMIT$DESCRIPTION OF OPERATIONS below <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />CERTIFICATE HOLDERCANCELLATION <br />SHOULDANYOFTHEABOVEDESCRIBEDPOLICIESBECANCELLEDBEFORE <br />THEEXPIRATIONDATETHEREOF,NOTICEWILLBEDELIVEREDIN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />© 1988-2009 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORDACORD 25 (2009/09) <br />OP ID: CR <br />10/01/2018 <br />Jeff Rubish, CIC <br />High & Rubish Insurance Agency <br />P.O. Box 3040 <br />6015 Farrington Rd. Ste 101 <br />Chapel Hill, NC 27517 <br />Jeffrey A. Rubish <br />919-913-1144913-913-1155 <br />jeff@highandrubish.com <br />COMMU-6 <br />Community Home Trust <br />PO Box 2315 <br />Chapel Hill, NC 27515 <br />Owners Insurance Company32700 <br />Hartford Fire Insurance Co <br />1,000,000 <br />AXX 911163810011/27/201711/27/2018 100,000 <br />X 5,000 <br />1,000,000 <br />2,000,000 <br />2,000,000 <br />X <br />1,000,000 <br />AX 911163810011/27/201711/27/2018 <br />AX <br />X <br />A 3501759201/02/201801/02/2019 1,000,000 <br />3501759201/02/201701/02/2018 1,000,000 <br />1,000,000 <br />B Dishonesty Bond22BPEAM806509/11/201809/11/2019 500,000 <br />Additional Insured: Orange County <br />ORANGEC <br />Orange County <br />Government <br />P.O. Box 8181 <br />Hillsborough, NC 27278 <br />DocuSign Envelope ID: 1C608BEC-B713-4BE4-9E53-CD92D598627F