2021-174-E Housing-Quality Inn sheltering amendment

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DocuSign Envelope ID:9A5998B9-B8C1-4BF9-AABD-B0624D1C9E6B 21QUALIINN V,IG„11T. ,VVJVVL DATE(MM/DD/YYYY) ACORD.. CERTIFICATE OF LIABILITY INSURANCE 11/24/2020 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Christie Scott McGriff Insurance Services PHONAME:NEo, 910 763-3431 FAX, 877-297-1096 A/C A/C,N Ext: No 1111 Military Cutoff Road#221 E-MAIL Christie.Scott@mcgriffinsurance.com Wilmington, INC 28405 INSURER(S)AFFORDING COVERAGE NAIC# 910 763-3431 The Cincinnati Insurance Company 10677 INSURER A: P Y INSURED INSURER B:Great American Alliance Insurance Co. 26832 Tarheel Lodging, LLC dba Quality Inn Northstone Insurance Company 13045 INSURER C: p Y 6110 Falconbridge Rd, Suite 200 The Cincinnati Insurance Company 10677 INSURER D: P Y Chapel Hill, NC 27517 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 CONTRACTOR 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. LT R TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY ETD0399829 8/15/2020 08/15/2021 EACH OCCURRENCE $1,000,000 CLAIMS-MADE �X OCCUR PREMISES ERENTED . r nce $500,000 MED EXP(Any one person) $1,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO- POLICY JECT [XI LOC PRODUCTS-COMP/OPAGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY ETD0399829 8/15/2020 08/15/2021 Ea aocid.n SINGLE LIMIT $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY Per accident $ B X UMBRELLA LIAB X OCCUR SUMB191130 8/15/2020 08/15/2021 EACH OCCURRENCE $50 000 000 EXCESS LIAB CLAIMS-MADE AGGREGATE $50 000 000 DED RETENTION$ $ C WORKERS COMPENSATION WCN6004438 8/15/2020 08/15/2021 X STATUTE EORH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 Y/N OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 A Liquor Liability ETD0399829 8/15/2020 08/15/2021 $1,000,000 B Employment EMP0401559 08/15/2020 08/15/2021 $1,000,000 Practices Liabili DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION Orange County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS. Hillsborough, INC 27278 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S26858601/M26334390 C H SC