2019-199-E Social Svc - Carolina Outreach counseling services

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DocuSign Envelope ID:C225CBFC-BC74-450D-8FD7-99E8F2A23E98 Client#: 1667554 35NCGCAR ACORD,., CERTIFICATE OF LIABILITY INSURANCE D310812ATE(M 7GGfYYYY) 3!0$12D19 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:if the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and Conditions of the policy,certain policles may require an endorsement.A statement on this certificate does not confer any rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: Vivian Hume ONE.,MCGrif Insurance$erVICeS PAIN ExI:$04 fi78-500 A1C Nv $$$751-3010 2108 W. Laburnum Ave Suite 300 E-MAIL ADDRESS: PO Box 17370 INSURERS)AFFORDING COVERAGE NAIC 9 Richmond,VA 23227 INSURER A:Phl]adeiphfa Indemnity Insurance cs. 18058 INSURED INSURER S:StarNst Msuranee company 40045 Carolina Outreach LLC INSURER C PO Box 11247 INSURER D Richmond,VA 23230 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURrzD NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF ADCLSUSR POLICY EFF POLICY EXP LIMITS LTR INSR YYVD POLICY NUMBER MMIDDIYYYY MMIDO A X COMMERCIAL GENERAL LIABILITY PHPKISS2152 10/0112018 10/0112019 EACH OCCURRENCE S 1 000 000 CLAIMS-MADE ❑X OCCUR PREMISES ERa ao v O n. $1 000 000 MED EXP(Any one person) s5,000 PERSONAL&ADV INJURY $1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 0,000,000 PRO- POLICY❑JECT LOG PRODUCTS-COMPIOPAGG $3,000,000 OTHER: $ A AUTOMOBILE LIABILITY PHPK1882152 0101120'18 101011201 MaI31IdenDtSINGLELIMIT 1,000,000 X ANY AUTO BODILY INJURY(Par parson) S OWNED SCHEDULED BODILY INJURY(Per accident] S AUTOS ONLY AUTOS PROPERTY DAMAGE HIRED AUTOS NLY $ X AUTOS ONLY X AUTOS ONLY (Par accident) A X UMBRELLA LIM X OCCUR PHLlB647596 1010112018 10/01/201 EACHOCCURRENCE $15000 000 EXCESS LIA$ CLAIMS-MADE AGGREGATE $15 00D 000 DED I X I RETENTION s20.000 _ $ B WORKERS COMPENSATION KEY0137631 1010112018.101011201 X PER oTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOPW ER ARTNERIEX1 ECUTIVE� NIA E.L.EACH ACCIDENTOFF $1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEEI S1,000,000 IFys describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1 000 000 A Professional Liab PHPK1982152 10/01/2018 1010112014 $1,000,000 Each Incidnt $3,000,000 Aggregate AbuselMolestation PHPK1882152 1010112018 10/011201 $100()0000,,/$2000000Agq DESCRIPTION OF OPERATIONS I LOG ATIONSI VEHICLES(ACCRD 101,Additlonal Remarks Scheduin,may he attached iI more space is required) CERTIFICATE HOLDER CANCELLATION 0 County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange ty THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 113 Mayo Street ACCORDANCE WITH THE POLICY PROVISIONS. Hillsborough,NC 27278 AUTHORIZED REPRESENTATIVE I p 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) 1 Of 1 The ACORD name and logo are registered marks of ACORD #S230832711M23083215 VRH