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DocuSign Envelope ID: 1BB65AEA-3E6A-45BE-8A7F-19FFOF9A712A OP ID: LP
<br /> —1
<br /> AC�Lt� DATE(MM/DD/YYYY)
<br /> CERTIFICATE OF LIABILITY INSURANCE 02/19/2019
<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 CONTACT
<br /> High&Rubish Insurance Agency PHONE FAX
<br /> P.O. Box 3040 A/C No Ext: A/C,No):
<br /> 6015 Farrington Rd.Ste 101 E-MAIL
<br /> Chapel Hill,INC 27517 PRODUCER
<br /> Jeffrey A. Rubish CUSTOMER ID#:KIDZU-1
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURED Kidzu Children's Museum INSURER A:Philadelphia Insurance Co
<br /> 201 S Estes Dr, Ste A9 INSURER B:Hartford Insurance Company 29424
<br /> Chapel Hill, NC 27514
<br /> INSURER C:
<br /> INSURER D:
<br /> 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 ADDTYPE OF INSURANCE L SUBR POLICY EFF POLICY EXP LIMITS
<br /> LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY
<br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> A X COMMERCIAL GENERAL LIABILITY PHPK1751189 02/20/2019 02/20/2020 PREMISES Ea occurrence $ 1,000,00
<br /> CLAIMS-MADE � OCCUR MED EXP(Any one person) $ 10,00
<br /> PERSONAL&ADV INJURY $ 1,000,00
<br /> GENERAL AGGREGATE $ 2,000,00
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00
<br /> POLICY 7
<br /> PROEC� 7 LOC $
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
<br /> (Ea accident) $ 1,000,00
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> ALL OWNED AUTOS BODILY INJURY(Per accident) $
<br /> SCHEDULED AUTOS PHPK1751189 02/20/2019 02/20/2020
<br /> PROPERTY DAMAGE $
<br /> A X HIRED AUTOS (PER ACCIDENT)
<br /> A X NON-OWNED AUTOS $
<br /> UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00
<br /> X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,00
<br /> A PHUB610859 02/20/2019 02/20/2020
<br /> DEDUCTIBLE $
<br /> X RETENTION $ 10,000 $
<br /> WORKERS COMPENSATION WC STATU- OTH-
<br /> AND EMPLOYERS'LIABILITY TORY LIMITS ER
<br /> B ANY PROPRIETOR/PARTNER/EXECUTIVEY/N �(22WECNY6264 04/10/2018 04/10/2019 E.L.EACH ACCIDENT $ 1,000,00
<br /> OFFICER/MEMBER EXCLUDED' N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
<br /> A PHPK1751189 SEXUAL ABUSE AND MOLESTAT 31/2018 08/31/2019 Occurence 1,000,000 08/
<br /> Aggregate 2,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101 Additional Remarks Schedule,if more space is required)
<br /> Childrens Museum/located at University Place, 201 Estes Drive Suite A9
<br /> Chapel Hill, N C 27514
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> ORANG-3
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Orange Count Human Services THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> g y ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Program
<br /> C/O Allen Coleman
<br /> P.O. Box 8181 AUTHORIZED REPRESENTATIVE
<br /> Hillsborough, NC 27278 P, 3p
<br /> ©1988-2009 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD
<br />
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