2021-145-E Finance- Habitat for Humanity outside agency agreement

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DocuSign Envelope ID:2A6C2779-DD90-42AA-8E9F-5C9900BBFA38 AC"R" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 07/27/2020 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 HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or 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 Summit Insurance Group Inc. PHONE Teena Raymond FAX PO BOX 2485 A/C No Ext: (704)659-2141 A/C No: (704)659-2148 Huntersville, NC 28070-2485 E-MAIL ADDRESS: CIBSSISt@SUmInS.COm License#: 7638156 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Builders Mutual Insurance Company-Tip 10844 INSURED INSURERB: Consolidated Pro ram Ins.Services Inc. Habitat For Humanity Orange County, NC, Inc. INSURERC: 88 Vilcom Center Dr. Ste L110 INSURERD: Chapel Hill, NC 27514 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 00008390-510522 REVISION NUMBER: 4 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MMIDD/YYYY MM/DDIYYYY A X COMMERCIAL GENERAL LIABILITY Y CPP 0058155 07 04/01/2020 04/01/2021 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES Ea occurrence $ 1,000,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY jE LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ Employee A AUTOMOBILE LIABILITY PCA 0009233 07 04/01/2020 04/01/2021 Ee aocid.nINED SINGLE LIMIT $ 1 OOO OOO X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident Medical payment $ 5000 A X UMBRELLA LIAB OCCUR MUB 0001005 03 04/01/2020 04/01/2021 EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 DED 7X I RETENTION$ 10,000 $ A WORKERS COMPENSATION pWC 1011231 07 04/01/2020 04/01/2021 X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED' N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 Volunteer/Accident P NHH000489 04/01/2020 04/01/2021 Per Claim 10,000 B olicy Aggregate Indemnity 250,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Orange County Government is considered an additional insured with respects to the General Liability per written contract CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Orange County Government ACCORDANCE WITH THE POLICY PROVISIONS. 300 West Tryon Street Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE (TLR) ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by TLR on July 27,2020 at 10:01AM