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DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE <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 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 />CONTACTPRODUCERNAME: <br />FAXPHONE(A/C, No):(A/C, No, Ext): <br />E-MAILADDRESS: <br />PRODUCER <br />CUSTOMER ID #: <br />INSURER(S) AFFORDING COVERAGE NAIC # <br />INSURED INSURER A : <br />INSURER B : <br />INSURER C : <br />INSURER D : <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 />ADDL SUBRINSR POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITSPOLICY NUMBERLTR (MM/DD/YYYY) (MM/DD/YYYY)INSR WVD <br />GENERAL LIABILITY EACH OCCURRENCE $ <br />DAMAGE TO RENTEDCOMMERCIAL GENERAL LIABILITY $PREMISES (Ea occurrence) <br />CLAIMS-MADE OCCUR MED EXP (Any one person) $ <br />PERSONAL & ADV INJURY $ <br />GENERAL AGGREGATE $ <br />GEN'L AGGREGATE LIMIT APPLIES PER:PRODUCTS - COMP/OP AGG $ <br />PRO-$POLICY LOCJECT <br />COMBINED SINGLE LIMITAUTOMOBILE LIABILITY $(Ea accident) <br />ANY AUTO BODILY INJURY (Per person) $ <br />ALL OWNED AUTOS BODILY INJURY (Per accident) $ <br />SCHEDULED AUTOS PROPERTY DAMAGE $(PER ACCIDENT)HIRED AUTOS <br />$NON-OWNED AUTOS <br />$ <br />UMBRELLA LIAB EACH OCCURRENCE $OCCUR <br />EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br />$DEDUCTIBLE <br />$RETENTION $ <br />WC STATU- OTH-WORKERS COMPENSATION TORY LIMITS ERAND EMPLOYERS' LIABILITY Y / NANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $N / AOFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH)E.L. DISEASE - EA EMPLOYEE $ <br />If yes, describe under E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <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 />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />© 1988-2009 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORDACORD 25 (2009/09) <br />OP ID: LP <br />01/30/2020 <br />Jeffrey A. Rubish,CICHigh & Rubish Insurance Agency <br />P.O. Box 30406015 Farrington Rd. Ste 101Chapel Hill, NC 27517 <br />Christopher Ives Rubish <br />919-913-1144 919-913-1155 <br />jeff@highandrubish.com <br />ORANG-2 <br />Orange Cty Rape Crisis Center <br />1506 E. Franklin St, Ste 302 <br />Chapel Hill, NC 27514 <br />Philadelphia Insurance Co <br />Hartford Insurance Company 29424 <br />1,000,000 <br />AX X <br />PHPK2029814 10/10/2019 10/10/2020 100,000 <br />X 5,000 <br />X abuse/Moles. $mil PHPK2029814 10/10/2019 10/10/2020 1,000,000 <br />X prof liab-$2 mill PHPK2029814 10/10/2019 10/10/2020 2,000,000 <br />2,000,000 <br />Liq Liab 1,000,000 <br />1,000,000 <br />AX <br />X PHPK2029814 10/10/2019 10/10/2020 <br />X <br />B 500,000 <br />22WBCNY9475 04/24/2019 04/24/2020 500,000 <br />500,000 <br />A Directors & Office PHSD1245509 06/30/2019 06/30/2020 D&O 1,000,000 <br />B Dishonesty Bond 22BDDHK0780 06/03/2019 06/03/2020 Bond 300,000 <br />Additional Insured: Orange County (Professional Liability limits are$1,000,000 occurrence / $2,000,000 aggregate) <br />ORANGEC <br />ORANGE COUNTY <br />Government <br />200 South Cameron Street <br />P O Box 8181 <br />Hillsborough, NC 27278 <br />DocuSign Envelope ID: DD5913BF-4E43-4D9A-AE17-BB4BC81296BE