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DocuSign Envelope ID: F396A7D5-62F3-4B5B-A968-F49AA5397EFF <br /> 0 DATE(MMAIDIYYYY) <br /> A`C>Ra CERTIFICATE OF LIABILITY INSURANCE <br /> 07/03/2019 <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 policyfiesf 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 /> COI <br /> PRODUCER NAME CT LUkE RIC]gSheB <br /> Carolina National Insurance Agency PHONE �_ _ 25 FAX <br /> PO Box 1028 no aL <br /> Carrboro, NC 27510 INSURERS AFFORDI NO 00VERAGE NAIC Ir <br /> INSURER A Insurance CDmpa <br /> INSURED INSURER B: <br /> INSURER C <br /> Empowerment Inc INSURERD: <br /> 109 N Graham St #200 INSURERE: <br /> Chapel Hill NO 27516 <br /> INSURER I= <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 /> iLTR TYPE OF INSURANCE ADDL POLICY NUMBER MMID Y EFF MMIQ�E%YY LIMITS <br /> LTRimin <br /> GENERAL LIABILITY CPS3189063 06/16119 06/16/20 AAOETURRENTE $ <br /> '°' X COMMERCIAL GENERAL LIABILITY P13EMISES Ea accu nce $ <br /> CLAIMS-MADE OCCUR MED Ex An one person S <br /> PERSONAL&ADV INJURY $U00,000 <br /> GENERAL AGGREGATE $2 4D <br /> G FNT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $InClUded <br /> Jr <br /> POLICY PRO LOC $ <br /> U <br /> AUTOMOBILE LIABILITY Me a i INGLE LIMIT <br /> daarnt <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Peracciderd) S <br /> AUTOS AUTOS <br /> NON-OWNED PROPERTY DAMAGE $ <br /> HIRED AUTOS AUTOS accident <br /> S <br /> UMBRELLA LIAR OCCUR EACH OCCURRENCE S <br /> EXCESS LIAR CLAIMS-MADE AGGREGATE S <br /> DED I I RETENTION S S <br /> WORKERS COMPENSATION WC STATUSMMITS OTH- <br /> AND EMPLOYERS'LIABILITY <br /> ANY PROP RIETORIPARTNERIEXECUTIVE Y <br /> N 1 A E.L.EACH ACCIDENT $ <br /> OFFICERIMEMBER EXCLUDED? <br /> (Mandatary In NH) E.L.DISEASE-EA EMPLOYE $ <br /> If yes,descrlbe under E.L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS betow <br /> A PROPERTY CPS3189063 06/16/19 06/16/20$4,794,349 TIV <br /> DESCRIPTTON OF OPERATIONS LOCATIONS i VEHICLES (Attach ACORD 101,Additional Ranarks Schedule,if more space Is required) <br /> See Attached ACORD 101 <br /> CERTIFICATE HOLDER CANCELLATION <br /> I <br /> Orange County Government SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Attn: Risk Manager ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 200 S Cameron Street <br /> PO Box 8181 AUTHORIZED REPRESENTATIVE <br /> Hillsborough, NC 27278 � Q�e fie✓ <br /> ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD <br />