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DocuSign Envelope ID:8C3AC364-2OA8-477A-92A7-8FBD4923E2DO <br /> Erie CERTIFICATE OF INSURANCE DATE ISSUED(MM/DD/YY) <br /> 1 nsurance® —THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY— <br /> v19/21 <br /> Home Office - 100 Erie Insurance Place • Erie,Pennsylvania 16530 • 814.870,2000 <br /> Toll free 1.800.458.0811 • Fax 814.870.3126 • wwv✓.erleinsurance.com <br /> NAME AND ADDRESS OF AGENCY AFFINITY INSURANCE GROUP AGENT'S NO. <br /> 800 W WILLIAMS ST STE 231H C ERE NS A C 0 PANY <br /> JJ3788 Co.:D ER E INS RAN E PROPERTY&CASUALTY COMPANY <br /> APEX,NC 27502-5204 Co.:E ErjIE INSURANCE EXCHANGE Not Applicable <br /> r e Indemnl Co, ttorne -in-Fact in NY <br /> INSURANCE COMPANY OF NEWYORK <br /> (919)296-3787 Co,v G FLAGSHIP CITY INSURANCE COMPANY <br /> This certificate is issued for information purposes only and confers <br /> NAME AND ADDRESS OF NAMED INSURED no rights on the certificate holder. It does not affirmatively or <br /> negatively amend,extend,or otherwise alter the terms,exclusions <br /> INSTITUTE OF ART THERAPY and conditions of insurance coverage contained in the polfcy(ies) <br /> 200 N GREENSBORO ST,Unit#D-6 indicated below.The terms and conditions of the policy(ies)govern <br /> the insurance coverage as applied to any given situation.Limits <br /> CARRBORO,NC 27510-1838 shown may have been reduced by claims paid.This certificate of <br /> insurance does not constitute a contract between the issuing <br /> insurer(s), authorized representative or producer and the <br /> certificate holder. <br /> This is to certify that policies,as Indicated by the Policy Number below,are in force for the Named Insured at the time that the Certificate is being issued. <br /> LTR GO Add I TYPE OF INSURANCE POLICY NUMBER LIMITS <br /> E FX-]GENERAL LIABILITY 5/4/20 5/4/21 EACH OCCURRENCE 1,0001000 <br /> FM COMMERCIAL GENERAL LIABILITY Q41 0451038 <br /> FIRE DAMAGE(Any One Fire) 1,000,000 <br /> ❑CLAIMS MADE © OCCUR MED EXP(Any One Person) 5,000 <br /> ❑ PERSONAL&ADV.INJURY 1,000,000 <br /> ❑ GENERAL AGGREGATE 2,000,000 <br /> GENTAGGREGATE LIMITAPPLIES PER: PRODUCTS-COMP/OPAGG 2,000,000 <br /> ❑POLICY X❑PROJECT ❑LOG <br /> ❑ AUTOMOBILE LIABILITY BODILYINJURY <br /> ❑ "ANYAUTO"(NON D HIRE , (EACH PERSON) $ <br /> ❑ A OWNED E HLACCIDENT) $ <br /> ❑ HIRED PROPERTYDAMAGE $ <br /> ❑ NON-OWNED BODILYINJURYAND <br /> ❑ GARAGE PRO COMBINED AGE $ <br /> ❑EXCESS LIABILITY EACH OCCURRENCE $ <br /> ❑ OCCURRENCE AGGREGATE $ <br /> ❑ RETENTION $ $ <br /> E WORKERS COMPENSATION& STATUTORY <br /> g9 5400347 5/4/20 5/4/21 <br /> EMPLOYERS LIABILITY Q BODILY ACCIDENT $ 100,000 EACH ACCIDENT <br /> INJURY DISEASE $ 500,000 POLICY LIMIT <br /> BY DISEASE $ 100,000 EACH EMPLOYEE <br /> OTHER <br /> DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br /> Orange County,its officers,official agents and employees as an additional insured on the General Liability Policy,form CG2012.Included is <br /> a Workers'Compensation Waiver of Subrogation. County shall be notified at least 30 days in advance of cancellation or material change in <br /> coverage. <br /> CANCELLATION: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIV- <br /> ERED IN ACCORDANCE WITH THE POLICY PROVISIONS. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the <br /> terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer <br /> rights to the certificate holder in lieu of such endorsement(s). <br /> NAME AND ADDRESS OF CERTIFICATE HOLDER <br /> Orange County AUTHORIZED REPRESENTATNE <br /> Attn:Risk Management 7 <br /> 200 South Cameron Street <br /> Hillsborough,NC 27278 <br /> EIG6230 8/11 <br /> Page 1 of 2 <br />