2013-479 Health - Patterson Dental to procure and deliver the products & services as it relates to TRG Conseutive Training $1,400

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® DATE(MM/DD/YYYY) A�°' CERTIFICATE OF LIABILITY INSURANCE 11/19/2013 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 C NT CT Marsh USA Inc. NAME: 333 South 7th St.,Suite 1600 PHONE FAX A/C No Minneapolis,MN 55402-2400 ADDRESS: Attn:Minneapolis.certrequest @marsh.com FAX 212-948-0804 INSURERS AFFORDING COVERAGE NAIC# 01 5777-STND-GAWU-1 3-14 INSURER A:Sentry Insurance A Mutual Co 24988 INSURED INSURER B:North American Elite Insurance Company 29700 Patterson Dental Supply,Inc. 1031 Mendota Heights Road INSURER C:Sentry Casualty Company 28460 St.Paul,MN 55120 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: CHI-004794392-01 REVISION NUMBER:7 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. NSR ILTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM/DOY/YYYY MM DDNYYY LIMITS A GENERAL LIABILITY 900531203 04/28/2013 04/28/2014 EACH OCCURRENCE $ 2,000,000 X DAMAGE O RENTED 1,000,000 COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE M OCCUR MED EXP(Any one person) $ B PERSONAL&ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 4,000,000 X POLICY PRO LOC $ A AUTOMOBILE LIABILITY 900531204(AIDS) 04/28/2013 04128/2014 Ea acciden SINGLE LIMIT 3,000,000 A X ANY AUTO 900531205(MA) 04/28/2013 04/2812014 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Par accident B X UMBRELLA LIAB X OCCUR H200000499-01 04/28/2013 04/28/2014 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED I I RETENTION$ $ A WORKERS COMPENSATION 900531201(AIDS) 04/28/2013 04/28/2014 X WC STATU- OTH- AND EMPLOYERS'LIABILITY 900531202 Hl,WI 04/28/2013 04/28/2014 1,000,000 C ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N ( ) E.L.EACH ACCIDENT $ C OFFICER/MEMBER EXCLUDED? NIA 90-05312-10 CA 04/28/2013 04/28/2014 1,000,000 (Mandatory In NH) ( ) E.L.DISEASE-EA EMPLOYE $ If es,describe under E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Orange County Health Dept is/are included as additional insured if required by written contract under General Liability policy. CERTIFICATE HOLDER CANCELLATION Orange County Health Dept SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn:Pascal Moore THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS. Hillsborough,NC 27278-8181 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD