2019-666-E Emergency Svc - Orange County Schools CBT agreement

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DocuSign Envelope ID:7153675D-647B-4D5F-AA47-OABA1B509205 DATE(MMIDDIYYYYI CERTIFICATE OF LIABILITY INSURANCE 7/17/2018 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 BOLDER. IMPORTANT: It the certificate holder is an ADDITIONAL INSURED,the pollcytlesy must 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 endorsement(s). PRODUCER CONTACT NAME: Laura Falan a AssuredPartners of North Carolina, LLC PHONE 919.645-1584 (AdCFAX, No:919 582-1999 4505 Falls of Neuse Road,Suite 350 E-MAIL Raleigh NC 27609 ADDRESS: laura.falanga@assuredpartners.com INSURER 5 AFFORDING COVERAGE NAIC B INSURER A:Peerless Insurance C ompany 24198 INSURED NCDEPTO-01 INSURER e North Carolina Department of Public Instruction INSURER C 301 North Wilmington St INSURERD: Raleigh NC 27601 INSURER E: INSURER F: _ COVERAGES CERTIFICATE NUMBER:905231489 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY 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. INSR TYPE OF INSURANCE DDL SU R POLICY NUMBER MhWDO OLICY EFF MMPOLICY - LIMITS LTR A X COMMERCIAL GENERAL LIABILITY Y GL8058891 71UZO18 7/1/2019 EACH OCCURRENCE $1,00D,D00 DAMAGE TO RENTED CLAIMS-MADE FRI OCCUR PREMISES(Ea occurrence) $100A00 MED EXP Any one person $15,000 PERSONAL&ADV I NJU RY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3.000.000 x POLICY❑JE T LOC PRODUCTS-COM Plop AGG S OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Me accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Peracddent) S AUTOS NON--OWNEO PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per acciden a UMBRELLA LIAB OCCUR EACH OCCURRENCE $ E%CE85 LIAB CLAIMS-MADE AGGREGATE $ DED RETENTIONS S WORKERS COMPENSATION AND EMPLOYERS'IJABILITY YIN STATUTE ER ANY PROPRIETORfPARTNEfilE CUT4 11E ❑ N/A E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S It yes,desrAba under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Addltlonal Remarks Schedule,may be attached If more apace Is required) Medical Professional Liability In the amount of$1,000,000 per occurrence and$3,000.000 aggregate is Included in the policy Medical Payments extend to students enrolled in the Work Farce Development Programs,In the amount of$15,000.❑renge County Schools are listed as an Additional Insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Orange County Schools 200 East King Street AUTHORIZED REPRESENTATIVE Hillsborough NC 27278 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD