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Client #: 955852 04SENIOCARI 16 ACORDTM C OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 01/24/2013 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 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 BB &T Insurance Services, Inc. NAME: PHONE 888 743 -2217 1FAx 8 888279861 AIC, No Ext : A/C, No : 414 Gallimore Dairy Road Suite F E -MAIL. ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # Greensboro, NC 27409 INSURERA: Evanston Insurance Company 35378 INSURED Senior Care of Orange County PO Box 8181 Attn Day Health Center Hillsborough, NC 27278 -8181 INSURER B : INSURER C INSURER D INSURER E: INSURER F $501_000 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 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 LTR TYPE OF INSURANCE ADDL INSR SUB WVD POLICY NUMBER POLICY EFF MMIDDIYY YY POLICY EXP MMIDD LIMITS A GENERAL LIABILITY SM888119 7/1312012 07/13/2013 EACH OCCURRENCE $ 000 000 X COMMERCIAL GENERAL LIABILITY PRM15�S Ea occur ence $501_000 MED EXP Any one person) $ 000 ::X1 CLAIMS -MADE 1:1 OCCUR PERSONAL & ADV INJURY $15000,000 X BI /PD Ded:5,000 GENERAL AGGREGATE $ 3,000,000 PRODUCTS �- COMP /OP AGG $ GEN'L AGGREGATE LIMIT APPLIES PER: $ F-1 POLICY PRO- LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS OP RT DAMAGE PROPERTY accident) $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DE❑ I I RETENTION $ $ WORKERS COMPENSATION WC STATU- 1OTH- TORY LIMITS AND EMPLOYERS' LIABILITY Y N ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ N/A E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) E.L: DISEASE -� POLICY LIMIT $ ..If yes, describe under DESCRIPTION OF OPERATIONS below A Error & Omissions SM888119 7113/2012 07/131201 Limit 1: $1,000,000 Limit 2: $3,0003000 Deductible: $5,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Professional Liability Limit #1: 1,000,000 Ded. #1: $5,000.00 Limit #2: 3,000,000 Food and Beverages consumed on insured's premises are covered under the operations coverage of the General Liability policy. CERTIFICATE HULUEK IorANULLLA I IVIV Senior Care of Orange County PO Box 8181 Attn: Day Health Center Hillsborough, NC 27278-8181 ACORD 25 (2010105) 1 of 1 #S9861295/M9861250 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I;S wwa 4. *104o ft. 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD JUSC