2019-552-E DSS - Boomerang Youth outside agency agreement

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DocuSign Envelope ID: BAEB77DF-C7A7-42CA-A5D5-OCF96776927C -� ® DATE(MMIDDIYYYY) A Ro CERTIFICATE OF LIABILITY INSURANCE OBI2512019 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 policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endomement(s), PRODUCER CONTACT Dlane Nadeau NAME: Business Insurers of Carolinas PHONE (919)966-4611 FAX (919)968-8991 AIC Na Ext' tAIC,No): 800 Eastowne Drive,Suite 208 E-MAIL dnadeau®business-Ensurers-com ADDRESS: PO Box 2536 INSURER(S)AFFORDING COVERAGE NAIC M Chapel Hill NC 27515-2536 INSURERA; USLI INSURED INSURER B: Amguard Insurance Company Boomerang Youth Inc INSURER C: United States Liability Insurance Company 25895 825-A North Estes Dr INSURER D: INSURER E: Chapel HIII NC 27614 1NSURER F; COVERAGES CERTIFICATE NUMBER: 19-20 Cert REVISION NUMBER: THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER❑OCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE IN5URANCE AFFORDED 13Y 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. ILra POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE IN ❑ wV0 POLICY NUMBER MMIDDffYYY MMIDDNYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 _OIAIMS-MADE �OCCUR PREM I SES Me occummCa a 1OO,OUO MED EXP(Any one arson) $ 5,000 A NPP1689542 07/01/2019 07101Q020 PERSONAL&ADVINJLRY $ 1,000,000 'OTHER:L AGGREGATE LI MIT APPUESPER: GENERAL AGGREGATE $ 2,000,000 X POuCY JEG�T LOC PRODUCTS-COMPIOPAGG $ 2.000.000 Abuse&Molestation s 100,0001$200,000 AUTOMOBILE LIABILITY COMBBII EDISINGLE LIMIT $ (EaANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY tear accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERLY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accldenl UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LJAB CLAIMS-MADE AGGREGATE $ DEQ I I RETENTION 5 8 WORKERS COMPENSATION Xi PER STATUTE ER AND EMPLOYERS'LIABILITY Y r N ANY PROPRIETORIPARTNMEYECUTIVEIM NIA R2VVC086650 0710112U19 07/01/2020 IOE E.L EACHACCNT s 100,000 B OFFICEREMBEREXCLUDED7 Mandatory In NH E-L DISEASE-EA,EMPLOYEE S '100,000 Il yas,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Each Occurence $1,000.000 Directors&Officers C N001570583C 0710112019 0710112020 Aggregate $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORO 101,AddRional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Orange County Human Services ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 8181 AUTHORIZED REPRESENTATIVE Hillsborough NC 27279 0 1988-2015 ACORD CORPORATION, All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD