2013-480 Health - Patterson Dental to provide upgrade existing software and other eServices $12,000

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°® CERTIFICATE OF LIABILITY INSURANCE DATE 11/19/12013 2013 IYYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 'ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES 3ELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED 2EPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. MPORTANT: 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). ODUCER C NT ACT Marsh USA Inc. NAME: 333 South 7th St.,Suite 1600 PHONE A/C No): Minneapolis,MN 55402-2400 E-MAIL Attn:Minneapolis.certrequest @marsh.com FAX 212-948-0804 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# 15777-STND-GAWU-13-14 INSURER A:Sentry Insurance A Mutual Cc 24988 SURED 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. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM POLICY EFF DD/YYYY MW IDDNYW LIMITS A GENERAL LIABILITY 900531203 04/28/2013 04/28/2014 EACH OCCURRENCE $ 2,000,000 X DAMAGE TO REN ED 1,000,000 COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE 71 OCCUR MED EXP(Any one person) $ 0 PERSONAL&ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 4,000,000 I JECT X POLICY F PRO LOC $ A AUTOMOBILE LIABILITY 900531204(AOS) 04/28/2013 04/28/2014 COMBINED SINGLE LIMIT 3,000,000 Ea accident A X ANY AUTO 900531205(MA) 04/28/2013 04/28/2014 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS NO OWNED PROPERTY DAMAGE $ HIRED AUTOS P $ AUTOS (Per a ident B X UMBRELLA LIAB X OCCUR 1-1200000499-01 04/28/2013 04/28/2014 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION$ $ A WORKERS COMPENSATION 900531201(AOS) 04/28/2013 04/28/2014 X I W'C STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS R C ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 900531202(HI,WI) 04/28/2013 04/28/2014 E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? NIA C (Mandatory in NH) 90-05312-10(CA) 04/28/2013 04/28/2014 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If es,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,It 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(2010105) The ACORD name and logo are registered marks of ACORD