2021-184-E Housing-NC Coalition to End Homelessness database management

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DocuSign Envelope ID:3A8322DF-7E96-4ECD-9623-106BF4E7D3FD DATE(MM/DD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 01/05/2021 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 INSURERS),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 DAVID BRASWELL NAME: INSURE /CONN0 Ext: (919)781-1115 A/XC,No: (919)783-6427 2607 GLENWOOD AVENUE(27608) E-MAIL DBRASWELL@INSURE-NC.COM ADDRESS: PO BOX 31508 INSURER(S)AFFORDING COVERAGE NAIC# RALEIGH NC 27622 INSURERA: AUTO-OWNERS INSURANCE COMPANY 18988 INSURED INSURER B: TRAVELERS INDEMNITY COMPANY OF AMERICA 25666 INSURER C: NORTH CAROLINA COALITION TO END HOMELESSNESS INC INSURER D: PO BOX 27692 INSURER E: RALEIGH NC 27611-7692 INSURER F: COVERAGES CERTIFICATE NUMBER: LIABILITY CERT 2021-22 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 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 INSURANCEADDLSUBR POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PREM SES Ea oNcE ante $ 300,000 MED EXP(Any one person) $ 10,000 A Y Y 35658183 01/12/2021 01/12/2022 PERSONAL&ADV INJURY $ 1,000,000 GEN-LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 X JECT LOC PRODUCTS $POLICY ❑ PRO 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LAB HCLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION xi STATUTE ERH AND EMPLOYERS'LIABILITY Y/N 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ B OFFICER/MEMBEREXCLUDED? NIA Y UB-OK464798-21-42 01/30/2021 01/30/2022 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) IF REQUIRED IN A WRITTEN CONTRACT,LANDLORD(MARBLE EMPIRE PROPERTIES LLC)AND MANAGER(EMPIRE HISTORIC DEVELOPMENTS INC)ARE ADDITIONAL INSUREDS FOR GENERAL LIABILITY AS PER FORM 55091 05/17ATTACHED. SUBROGATION IS WAIVED IN FAVOR OF LANDLORD AS PER FORM 55091 05/17 AND FORM WC 00 03 13(00)ATTACHED. RE:BUILDING LEASE AT 310 N HARRINGTON STREET,RALEIGH,NC 27603 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN MARBLE EMPIRE PROPERTIES LLC AND EMPIRE HISTORIC ACCORDANCE WITH THE POLICY PROVISIONS. DEVELOPMENTS INC 133 FAYETTEVILLE ST 6TH FL AUTHORIZED REPRESENTATIVE RALEIGH NC 27601 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD