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DocuSign Envelope ID: 1056F994-88AA-4336-8102-E1F3178D3BE7 <br /> OP ID: LP <br /> CERTIFICATE OF LIABILITY INSURANCE DATEIMMIDDIYYYY) <br /> ik� 1 01/17/2019 <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 endorsements). <br /> PRODUCER CONTACT NAME: Jeff Rubish <br /> High&Rubish Insurance Agency PHONE F <br /> P.O.Box 3040 M. 919-913-1144 AIC Nn:819-913-1155 <br /> 6015 Farrington Rd.Ste 101 E-MAIL <br /> Chapel Hin,7IC 27517 PRooucERnatalie h1 handru6ish.Com <br /> Jeffrey A.Rubish CUSTOMERo •OCIM--1 <br /> INSURE S AFFORDING COVERAGE NAIC 4 <br /> INSURED Orange Congregations In INSURER A:Cincinnati Insurance Company 10677 <br /> Missions, Inc. 1NSURER R;Hartford Underwriters Ins. 30104 <br /> 300 Millstone Drive <br /> Hillsborough.NC 27278 INSURERC: <br /> INSURER 0 <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 SEEN REDUCED BY PAID CLAIMS. <br /> iNSR D POLICY EFF POLICY EXP UMI75 <br /> LTR TYPE OF INSURANCE POLICY NUMBER MMIOD MMID IDN-M) <br /> GENERAL LIABILITY EACH OCCURRENCE 3 2,000,0001 <br /> A X COMMERCIAL GENERAL LIABILITY X ECP0349072 10116/2018 10/1512021 PREMISES Ea occurrence $ 2,000,00 <br /> CLAIMS-MADE ❑X OCCUR MEO EXP(Any one person) $ 10,00 <br /> PERSONAL&ADV INJURY $ 2,000,00 <br /> GENERAL AGGREGATE $ 4,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP1oPAGG $ 4,000,00 <br /> X POLICY PRO- LOC 4 <br /> AUTOMOBILE LIABILITY COM SINED 8 1 NGLE LIMIT S 2,000,00 <br /> (Ea acddanq <br /> ANY AUTO BODILY INJURY(Per person) 5 <br /> ALL OWNED AUTOS BODILY INJURY(Per acdcant) 4 <br /> SCHEDULED AUTOS PROPERTY DAMAGE <br /> A x HIRED AUTOS F�A0349072 101151201 S 1011 SM021 (PER ACCIDENT) $ <br /> X NON-OWNED AUTOS $ <br /> a <br /> UMBRELLA LIAR OCCUR EACH OCCURRENCE 5 <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DEDUCTIBLE 5 <br /> RETENTION $ S <br /> WORKERS COMPENSATION! x WC STATIJ- OTH• <br /> AND EMPLOYERS'LIABILITY <br /> B ANY PROPRIETORIPARTNER/Fxr=CtMVE Y N/A 2WECBV6360 08f1812018 08118/2019 E.L.EACH ACCIDENT 4 100,00 <br /> OFFICERIMEMBER EXCLUDED? <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYE 4 100,00 <br /> If Ee nder <br /> Ci <br /> ORIPTiON OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 <br /> A Sexual Misconduct JECP0349072 10/1512018 10/1512021 Occurence 1,000,000 <br /> Aggregate 1,000,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES fAttach ACORD 101,Additional Remarks Schedule,II more space is required) <br /> Additional Insured Status Applies to Holder <br /> CERTIFICATE HOLDER CANCELLATION <br /> ORANG•1 <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES HE CANCELLED BEFORE <br /> ORANGE COUNTY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> P 0 Box 8181 <br /> 302 W.Tryon 5t. AUTHORIZED REPRESENTATIVE <br /> Hillsborough,NC 27278 <br /> Q 1988-2009 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD <br />