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DocuSign Envelope ID: D1DF359E-9612-459E-8293-F383F2149BD8
<br /> A ��0 CERTIFICATE OF LIABILITY INSURANCE DATE(M 06/27//2019 Y)
<br /> 019
<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 have ADDITIONAL INSURED provisions or be endorsed.
<br /> If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on
<br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT Lori Allred
<br /> NAME:
<br /> Jennings Bryan-Chappell Insurance Services PAHi�NNo Ext: (336)227-7458 C,No): (336)343-1000
<br /> PO Box 1118 E-MAIL lori@jbcins.com
<br /> ADDRESS:
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> Burlington NC 27216 INSURERA: Philadelphia Indeminity Ins.Co. 18058
<br /> INSURED INSURER B: Accident Fund General Insurance Company 12304
<br /> OE Enterprises,Inc. INSURER C:
<br /> 348 Elizabeth Brady Road INSURER D:
<br /> INSURER E:
<br /> Hillsborough NC 27278 INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: CL1962704522 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 ADDLSUBR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY)
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> DAMAGE To CLAIMS-MADE � OCCUR PREMISES Ea occurrence)l
<br /> $ 100,000
<br /> MED EXP(Any one person) $ 5,000
<br /> A PKPH6301920 06/30/2019 06/30/2020 PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> X POLICY ❑ PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> JECT
<br /> OTHER: Employee Benefits $ 1,000,000
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
<br /> (Ea accident)
<br /> X ANYAUTO BODILY INJURY(Per person) $
<br /> A OWNED SCHEDULED PKPH6301920 06/30/2019 06/30/2020 BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> X HIRED NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY /� AUTOS ONLY (Per accident)
<br /> Medical payments $ 5,000
<br /> X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 4,000,000
<br /> A EXCESS LIAB CLAIMS-MADE PHUB6301920 06/30/2019 06/30/2020 AGGREGATE $ 4,000,000
<br /> DED I X RETENTION $ 10,000 $
<br /> WORKERS COMPENSATION PER OTH-
<br /> AND EMPLOYERS'LIABILITY STATUTE X ER
<br /> YIN 500,000
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
<br /> B OFFICER/MEMBEREXCLUDED? ❑ NIA WC6301920 07/01/2019 07/01/2020
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000
<br /> If yes,describe under 500,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> $1,000,000 $2,000,000
<br /> A Professional Liability Sexual Abuse/Molestation PHSD1446381 06/30/2019 06/30/2020 $1,000,000 $2,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Cyber Liability Coverage PHSD1362300 Claims Made 06/30/18 to 06/30/19 Limit of Liability 1,000,000 Policy Aggregate$1,000,000
<br /> Deductibles$5,000 Each Loss
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
<br /> Orange County Government ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> P.O.Box 8181
<br /> AUTHORIZED REPRESENTATIVE y
<br /> Hillsborough NC 27278tgc�
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br />
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