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SOCIAL SERVICE PROFESSIONAL COVERAGE FORM DECLARATIONS <br />PRODUCER: <br />Personal Care & Assisted Living Insurance Center <br />P.O. Box 933 <br />Hanover, PA 17331 <br />POLICY NUMBER:2020-35634 <br />NAME OF INSURED AND MAILING ADDRESS: <br />RENEWAL OF NUMBER: 2019-35634 <br />Voices Together <br />88 Vilcom Center Dr. Suite 100 <br />Chapel Hill, NC 27514 <br />POLICY PERIOD: FROM 10/10/2020 10/10/2021TO <br />AT 12:01 A.M. STANDARD TIME AT YOUR MAILING ADDRESS SHOWN ABOVE <br />BUSINESS DESCRIPTION: Therapeutic music program for people with developmental disabilities <br />IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS <br />POLICY, WE AGREE WITH YOU TO PROVIDE THE COVERAGE AS STATED IN THIS POLICY. <br />LIMITS OF COVERAGE: <br />SOCIAL SERVICE PROFESSIONAL AGGREGATE LIMIT $3,000,000 <br />$1,000,000SOCIAL SERVICE PROFESSIONAL EACH EVENT LIMIT <br />PREMIUM <br />$840........................... <br />........................... <br />FORMS AND ENDORSEMENTS APPLICABLE TO THIS COVERAGE PART AND MADE PART OF THIS POLICY AT THE TIME OF ISSUANCE: <br />TOTAL PREMIUM:$840 <br />ANI-E069 SSP 02 19, ANI-E125 11 19, ANI-RRG-E02 01 17, ANI-RRG-E11 SSP 09 19, ANI-RRG-E32 01 17, ANI-RRG-E33 SSP 09 19, ANI-RRG-E42 SSP 09 19 <br />COUNTERSIGNED: BY <br />(AUTHORIZED REPRESENTATIVE) <br />THESE DECLARATIONS AND THE COMMON POLICY DECLARATIONS, IF APPLICABLE, TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE <br />FORM(S) AND FORMS AND ENDORSEMENTS, IF ANY, ISSUED TO FORM A PART THEREOF, COMPLETE THE ABOVE NUMBERED POLICY. <br />ANI-RRG-SSP <br />"NOTICE : This Policy is issued by your risk retention group. Your risk retention group may not be subject to all the <br />insurance laws and regulations of your State. State insurance insolvency guaranty funds are not available for your <br />risk retention group." <br />DocuSign Envelope ID: 81A61471-345A-47F9-8A2D-36F7929A6637