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DocuSign Envelope ID:6DC1ED22-B276-4193-B1F9-548B6AFFC7C5 V cat Y.0 1 riVi <br /> Ac�a CERTIFICATE OF LIABILITY INSURANCE `IaMIDDIYYYY, <br /> ��. [:OD:6/25/2019 <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(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 endorsementtsl• <br /> PRODUCER CONCT <br /> NAME Luke Riggsbee _ <br /> Carolina National Insurance Agency NE 37.919- 6_ 252 FAX PHO No): <br /> PO Box 1028 E-MAIL <br /> ADDRESS; lukeiMcniagency.corn <br /> Carrboro, NC 27510 INSURERS AFFORDING COVERAGE NAIC 9 <br /> INSURER A. <br /> INSURED INSURER R: <br /> INSURER C• _ <br /> Empowerment Inc INSURERD: T _� <br /> 109 N Graham St #200 INSURER <br /> E: <br /> Chapel Hill NC 27516 <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 SUBR POU-Y.EFF POLICY EXP LIMITS <br /> Lift POLICY NUMBER MMIDWYYYY MMIDDIYY <br /> A GENERAL"ABILITY x CPS3189063 06/16/19 d6116120 EACCHAOC CURRENCENTEEE $ <br /> D..Q]Q <br /> x I COMMERCIAL GENERAL LIABILITY PREMISE Ea ogcyrrenoa 5 i ounn <br /> CLAIMS-NIADE ®OCCUR MED EXP(Any one parson) S <br /> PERSONAL&ADV INJURY $ <br /> GENERAL AGGREGATE $ <br /> GEN'L AGGREGATE LRArr APPLIES PER; PRODUCTS-COMPIOP AGO $Included <br /> POLICY JECT <br /> PRO LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SING LIM <br /> Ea accdent S <br /> ANY AUTO BODILY INJURY(Par person) $ <br /> ALL OWNED SCHEDULED BODILY iNJURY[Per accident] S <br /> AUTOS AUTOS <br /> HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS Per acc dent <br /> S <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> E]SCESS LIAR HCLAIMS-MADE AGGREGATE S <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION WC STATU- OTFI- <br /> AND EMPLOYERS'LIABILITY YIN .LI <br /> ANY PROPWETORIPARTNERIEXECUTIVE❑ E.L.EACH ACCIDENT $ <br /> OFFICE RIM EMBER EXCLUDED? N I A <br /> (Mandatory in NHy E.L.DISEASE-EA EMPLOYE $ <br /> If yyes,desr�ibe under <br /> VS 'ON <br /> OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> A PROPERTY CPS3189063 06/16/19 06/16120$4,794,349 TIV <br /> DESCRIPTION OF OPERATIONS�LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) <br /> See Attached ACCRC 101 <br /> CERTIFICATE HOLDER CANCELLATION <br /> Orange County Government SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> PO Box 8181 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Hillsborough, NC 27278 <br /> AUTHORIZED REPRESENTATIVE <br /> ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25{2010105y The ACORD name and logo are registered marks of ACORD <br />