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DocuSign Envelope ID:6D5F41 E3-E7E2-4D6C-BE76-951 E8674450E
<br /> CHARHOU-01 DMASON
<br /> ACC�RL7 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
<br /> � - 1110212018
<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($),AUTHORIZED
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(les)must have ADDITIONAL INSURED provisions or be endorsed.
<br /> If SUEROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on
<br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTAG7 -
<br /> Summers Thompson Lowry,Inc, PaHic°°YID€No,Ext)r(9'19)968-4472 (AJCCFAX,No):(919)942-4221
<br /> 100 Europa Drive E-MAIL -
<br /> Suite 571 DDRESs;I'rlfo@ST1.Insure.com
<br /> Chapel Hill,NC 27517-2393
<br /> INSURER{S]AFFORDING,COVERAGE ____. NAIL# _
<br /> INSURER A:Philadelphia Ins Co
<br /> INSURED INSURER B:Carolina Mutual Insurance Inc.
<br /> Charles House Association INSURER C: _
<br /> Paul Klever
<br /> 7511 Sunrise Road INSURER D
<br /> Chapel Hill,NC 27514 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 LTRTYPE OF INSURANCE ADDL SU@R POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY - - EACH OCCURRENCE - 1,000,000
<br /> CLAIMS-MADE �OCCUR PHPK1791330 0511012618 0511012019 DAMAGE TORENTED 700,000
<br /> MED EXP An arte-person 6,000
<br /> PERSONAL.&MVINJURY 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL.AGGREGATE _ $ 3,000,000
<br /> POLICY❑JECT LOC PRODUCTS-COMPPOP_AGG 3,000,000
<br /> OTHER:
<br /> A COMBINED aci SINGLE LIMIT 1,000,00D
<br /> AUTOMOBILE LIABILITY ec'rieR S
<br /> ANY AUTO PHPK1791330 0511012111 115/10121111 eooILYINJURY IPe,person,
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS
<br /> y� p BODILY INJURY Peraccldent 5
<br /> AUTOS ONLY ' ALiT05 ONt LY i{7PERTY AMAGE —
<br /> sr saclden4
<br /> A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE 1,DDa,aDD
<br /> EXCESS LIAR CLAIMS-MADE PHUB621294 05/10/2018 0511012019 AGGREGATE
<br /> DED X RETENTIONS 10,000 comp ops 1,000,000
<br /> B 'JJ Wfl FMPL YERS'LSA ILiT x PER E DTH-
<br /> IAND EMPLOYERS'LIABILITY
<br /> IANYPROPRIETOWPARTNERIEXECUTIVE YIN
<br /> �i NIA
<br /> WC19051i-2017 0612512018 06I2512019 E.L.EACH ACCIDENT _ 5DQ,00fl
<br /> IOFFICEPJMEMB EXCLUDED? IJ 5Da,0a0
<br /> l(Mandatary In NHI E.L.DISEASE-EA EMPLOYE _
<br /> k If yes,doscrihe under 500,000
<br /> ❑ESCRIPTION OF OPERATIONS befow E.L.DISEASE-POLICY LIMIT S
<br /> A Molestation/Sexual PHPK1791330 05/1012018 05110/2019;Occurrence ! 1,000,000
<br /> A Molestation/Sexual PHPK1791330 05/1012018 05/1012019 Aggregate i 2,000,000
<br /> i
<br /> DESCRIPTION DF OPERATIONS I LOCATIONS I VEHICLES (ACORD 161,Additional Remarks Scheduta.may he attached if mare space is required)
<br /> For Information purposes
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Orange County Social Services ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Adult Services
<br /> PO Box 8181
<br /> Hillsborough,NC 27278 AUTHORIZED REPRESENTATIVE
<br /> ell, w ti,rr a 5
<br /> ACORD 25(2016/03) O 1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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