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DocuSign Envelope ID:94DODA4A-83C1-42A4-8FB2-44BO273OE7D2 <br /> Client#: 1877352 04EXCHACLUI <br /> DATE(MMIODfYYYY) <br /> ACORD. CERTIFICATE OF LIABILITY INSURANCE 08/02/2019 <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 policy(les)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 any rights to the certificate holder In lieu of such endarsement(s). <br /> PRODUCER CONTACT <br /> NAME: <br /> McGriff Insurance Services PNONE 888 743_gg17 Imc No,: 888$279861 <br /> Arc No Ext <br /> 414 Gallimore Dairy Road E-MAIL <br /> ADDRESS: <br /> Suite F INSURER(S)AFFORDING COVERAGE NAIC 4 <br /> Greensboro,NC 27409 INSURER A r Philadelphia Indemnity Insurance Co. 18058 <br /> INSURED INSURER B:Stonewood Insurance Company 11828 <br /> The Exchange Club Family Center in INSURER C:Mount Vernon Fire Insurance Company 26522 <br /> Alamance County <br /> INSURER D <br /> 200 N Main Street <br /> INSURER E <br /> Graham,NC 27253 <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 /> INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LIMITS <br /> LTR INSR WVD POLICY NUMBER MMfOWNW MMIDDIYYYY <br /> A X COMMERCIAL GENERAL LIABILITY PHPK1989088 7106/2019 0710612020 EACH <br /> OCCURRENCE $1 000 000 <br /> CLAIMS-MADE �OCCUR PREMISES [aE+�rrenca $100 000 <br /> MED EXP(Any one person} s5,000 <br /> PERSONAL&ADV INJURY $1,000,000 <br /> r,CTHER: <br /> L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 <br /> PRC PRODUCTS-COMPIoP AGG $2000 000 <br /> POLICY JECT LOC <br /> $ <br /> A AUTOMOBILE LIABILITY PHPK1989088 - — 7/06/2019 07/061202 E°agclden SINGLE LIMIT 1,000,000 <br /> ANY AUTO I <br /> BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLYE <br /> AUTOS <br /> x HIRED NON-OWNED Peres RTYDAMAGE $ <br /> AUTOS ONLYAUTOS ONLY <br /> $ <br /> an <br /> UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAM CLAIMS-MADE AGGREGATE $ <br /> DIED I I RETENTIONS $ <br /> OTH <br /> B WORKERS COMPENSATION WC10000748812019A 7/01/2019 07/01/202 X PERTUTE ER <br /> AND EMPLOYERS'LIABILITY <br /> ANY PRROPRIETER EXCLUDRtEED?ECUTIVE� NIA E.L.EACH ACCIDENT $100 000 <br /> OFF(Mandatary in NH) .E.L.DISEASE-EA EMPLOYEE $100 000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY UMIT $500,000 <br /> C Cyber Covera CY2111371 0713012019 0713012020 $1,000,000 <br /> A Professional Liab PHPK1989088 7/0612019 071061202 $1,000,0001$2,000,000 <br /> A Abuse]Molestation PHPK1989088 7/0512019 0710612020 $1,000,0001$2,000,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES{ACORD 101,Additional Remarks Schedule,may ha attached If more apace is required) <br /> 4**Workers Comp Information'* <br /> Other States Coverage <br /> CERTIFICATE HOLDER CANCELLATION <br /> Orange County Gov't SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> g Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Orange County, NC ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 200 South Cameron Street <br /> P.O.Box 8181 AUTHORIZED REPRESENTATIVE <br /> Hillsborough, NC 27278 <br /> klurha�q <br /> O 1988-2015 ACORD CORPORATION.All rights reserved. <br /> ACORD 25(2016103) 1 Of 1 The ACORD name and logo are registered marks of ACORD <br /> #S241066811M24106668 EB3 <br />