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DocuSign Envelope ID: B3FB92A5-8DCA-444B-BA7D-945F9A80BEF7 <br /> DIAPERB OP ID:SB <br /> '4CQ�2'0 CERTIFICATE OF LIABILITY INSURANCE DATS(MMroorrrrr) <br /> 1 0 4/1 5120 1 9 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGMTS 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 pallcy(€es) 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 Steve Booth <br /> BICfDHNT Insurance NAME; <br /> t!a Dominick Hucicat�ee 1'HONE 1.919-2$fi-T473 FAlX Nn:919-28fi5170 <br /> P O Box 52237 E-MAIL <br /> Durham,NC 27717 ADDRESS., <br /> Steve Booth INSURERS AFFORDING COVERAGE NAIC# <br /> INSURER A:Pennsylvania National 14990 <br /> INSURED Diaper Sank of NC,Inc. INSURER B;ArnTrust North America <br /> Michelle Old, ED <br /> 1311 E Club Blvd INSURERC: <br /> Durham, NC 27704 INSURERD., <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 /> NSR TYPE OF INSURANCE IYYYY POLICY NUMBER MM LTR IDD M LICY POLICY Y Mmoff Y LIMITS <br /> A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 <br /> CLAIMS-MADE M OCCUR x BPS 0706663 0210112019 02/01/2020 PREMISES Eacccurrence $ 50,00 <br /> X Business Owners MED EXP(Any one n) $ 10,00 <br /> PERSONAL&ADV INJURY f 1,000,00 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 <br /> POLICY❑JECT F1 LOC -PRODUCTS-COMPFOPAGG $ 2,000,00 <br /> OTHER: $ <br /> M BI RED SI NGLE U MIT <br /> AUTOMOBILE LIAeILITY Ea accident $ <br /> ANY AUTO BODILY INJURY[Per person] $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accdent) S <br /> AUTOS AUTOS <br /> HIRED AUTOS ANON S fED Orr accident 3 <br /> a <br /> UMBRELLA LEAS OCCUR EACH OCCURRENCE $ <br /> EXCESS LIA9 HCLAIMS-MADE AGGREGATE $ <br /> DED I I RETENTIONS $ <br /> WORKERS COMPENSATION PER TH- <br /> AND EMPLOYERS'LIABILITY STATUTE ER <br /> B ANY PROPRIETORIPARTNERIExECUTIVE YIN TWC3619574 04ID112019 04/01/2020 E.L.EACH ACCIDENT S 100,00 <br /> OFFICERIMEM9ER BXCLUDED7 NIA <br /> IMandatory In NH} E.L DISEASE-EA EMPLOYE S 100,00 <br /> It yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,00 <br /> DESCRIPTION OF OPERA TIONSI LOCATIONSI VEHICLES(AC ORD Ia1,Add 111onaI Remarks Schedule,may be attached IF my re space Is requ IredI <br /> non-profit diaper provider to needy families-distribution services for <br /> Orange County are covered <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Orange Co Government THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> P 0 Box 8181 <br /> Hillsborough,NC 27278 AUTHORIZE:0 REPRESENTATIVE <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD <br />