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DocuSign Envelope ID:23D77C78-12E7-4A83-8951-OC79FA06A2CD <br /> ACo® CERTIFICATE OF LIABILITY INSURANCE Ff018/1 <br /> (MMIDDIYYYY) <br /> �� 3/2020 <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 have ADDITIONAL INSURED provisions or be endorsed. <br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br /> this certificate does not confer rights to the certificate holder in lieu of such endorsements. <br /> PRODUCER CONTACT NAME: Michael Riggsbee,Jr. <br /> Titan Risk Consultants, LLC PHONE 919 636 3252 FAX <br /> C „ <br /> 107 Conner Drive,Suite 225 E-MAIL l.riggsbee@titanriskconsultants.com <br /> INSURERS AFFORDING COVERAGE NAICA <br /> Chapel Hill NC 27514 INSURER A: Mesa Underwriters Specialty Insurance Company 36838 <br /> INSURED INSURER e: The Phoenix Insurance Company 25623 <br /> Empowerment, Inc. INSURERC: United States Liability Insurance Company 25895 <br /> 109 N. Graham St.#200 INSURERD: <br /> INSURER E: <br /> Chapel Hill NC 27516 INSURERF: <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 SV8R POLICY EFF POLICY EXP <br /> LTR POLICY NUMBER fmmfDDffYYYIMM DDIYYYY LIMITS <br /> x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> CLAIMS-MADE OCCUR DAMAGE TO RENTED <br /> PREMISES Ea occurtence $ 100,000 <br /> MED EXP(Anyone person) $ <br /> A A MP0032010000695 06/16/2020 06/16/2021 PERSONAL&ADV INJURY $ 5,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> POLICY jE O- LOC PRODUCTS-COMPIOP AGG $ Included <br /> OTHER; $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> Ea accident <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY Per accident $ <br /> AUTOS ONLY AUTOS ( ) <br /> HIRED NON-OWNED PROPERTY pAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAR CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION �/ $ <br /> WORKERS COMPENSATION /� STATUTE ERH <br /> AND EMPLOYERS'LIABILITY Y I N <br /> B OFFICERIMEMBER EXCLUDED?EANY PROPRIETORfPARTNERIEX CUTIVE ❑ NIA UB-8NO99723-19-42-G 06/16/2020 06/16/2021 E.L.EACH ACCIDENT $ 500,000 <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 500.000 <br /> it yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT s 500,000 <br /> Professional Liability Each Claim $1,000,000 <br /> C PM1553951 07/29/2020 07/29/2021 Aggregate $1,000,000 <br /> Retention $2,500 <br /> DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space Is required) <br /> Certificate holder is added as Additional Insured as respects General Liability as required by written contract. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Orange County Government ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Attn: Risk Manager <br /> P.O. Box 8181 AUTHORIZED REPRESENTATIVE <br /> Hillsborough INC. 27278 <br /> Fax: Email: ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />