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1 ® DATE(MMIDDIYYYYâ–º <br /> AC oR° CERTIFICATE OF LIABILITY INSURANCE 1/28/2014 <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 be endorsed. If SUBROGATION IS WAIVED,subject to <br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder In lieu of such endomement(s). <br /> PRODUCER NAME <br /> ONTACT_Ellen Walker <br /> Business Insurers Of Carolinas PHONE (919)968-4 FAC .(919)968-8991 <br /> 800 Eastowne Drive, Suite 208 AEbmpAglkss:ewalker@business-insurers.com <br /> PO BOX 2536 INSURER(S) AFFORDING COVERAGE NAIC# <br /> Chapel Hill NC 27515-2536 INSURER ABrid efield Casualty <br /> INSURED INSURER B <br /> KAH Care, LLC, DBA: Right At Home INSURER C: <br /> 105 W Corbin St. , Ste 203 INSURER <br /> INSURER E: <br /> Hillsborough NC 27278 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:CL1412809967 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 L POLICY NUMBER MM DID MM/DD/Y1'YPY LIMITS <br /> LTR <br /> GENERAL LIABILITY EACH OCCURRENCE $ <br /> DAMAGE TO RENTEIT_ <br /> COMMERCIAL GENERAL LIABILITY PREMIS E UEa o ce $ <br /> CLAIMS-MADE F__1 OCCUR MED EXP(Any one person) $ <br /> PERSONAL&ADV INJURY $ <br /> GENERAL AGGREGATE $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ <br /> POLICY PRO LOC $JECT <br /> AUTOMOBILE LIABILITY 1 D I <br /> E accident <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> NON-OWNED PROPPEERTYY;DAMAGE $ <br /> HIRED AUTOS AUTOS (Per <br /> $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB HCLAIMS-MADE AGGREGATE $ <br /> DED I I RETENTION$ $ <br /> A WORKERS COMPENSATION xcluded officer: Ken X OR IIMIT ER <br /> AND EMPLOYERS'LIABILITY <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE YIN elrauth E.L.EACH ACCIDENT $ 5()0,000 <br /> OFFICER/MEMBER EXCLUDED? Y NIA <br /> (Mandatory In NH) C 0196-4371400 /9/2014 /9/2015 E.L.DISEASE-EA EMPLOYEE $ 500,000 <br /> If yes,describe under - <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 <br /> .DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,N more space is required) <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 /> Right At Home ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 6464 Center Street <br /> Ste 150 AUTHORIZED REPRESENTATIVE <br /> Omaha, NE 68106 / <br /> Ellen Walker/ELLEN <br /> ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> INS025on1nnsinl The Ar rilOn name and Inn^arc rcnicfcrarl mor4c^f Anni?r1 <br />