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I DATE(MMIDDIYYYY) <br /> �`�° 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 doe::not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT Ellen Walker <br /> NAME: <br /> Business Insurers Of Carolinas PHONE FYrI. (919)968-4611 (per (9191968-8991 <br /> 800 Eastowne Drive, Suite 208 -MAIL <br /> ADDRESS:ewalker@businesa-insurers.cum <br /> PO BOX 2536 INSURER 5 AFFORDING COVERAGE NAIC M <br /> Chapel Hill NC 27515-2536 INSURER A:Brid efield Casualty <br /> INSURED INSURER B: _ <br /> KAH Care, LLC, DBA: Right At Home INSURERC: <br /> 105 W Corbin St., Ste 203 INSURER D: <br /> INSURER E: <br /> Hillsborough NC 27278 1 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:CL1412809967 REVISION NOME ER: <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 /> I R L SU POLICY EFF <br /> L TYPE OF INSURANCE POLICY NUMBER <br /> T MPMLI pY EXP LIMITS <br /> R <br /> GENERAL LIABILITY EACH OCCURRENCE $ <br /> DAMAGE TO RENTED <br /> COMMERCIAL GENERAL LIABILITY PREMISES Ea occurre n $ <br /> CLAIMS-MADE EJ OCCUR MED EXP(Any one person) $ <br /> PERSONAL&ADVINJJRY $ <br /> GENERAL AGGREGAI E $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ <br /> POLICY PRO LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> Ea accident <br /> ANY AUTO BODILY INJURY(Per parson) $ <br /> ALL OWNED F 1 SCHEDULED BODILY INJURY(Per a;cidenl) $ <br /> AUTOS AUTOS <br /> NON-OWNED PROPERTY DAMAGE $ <br /> HIRED AUTOS AUTOS Per accident) <br /> $ <br /> UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED I I RETENTION $ <br /> A WORKERS COMPENSATION Excluded officer: Ken X WCSTATU- OR <br /> AND EMPLOYERS'LIABILITY <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N Helmuth E.L.EACH ACCIDENT $ 500,000 <br /> OFFICER/MEMBER EXCLUDED? a NIA <br /> (Mandatory In NH) WC 0196-4371400 /9/2014 /9/2015 E.L.DISEASE-EA EM'LOYE $ 500,000 <br /> H describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLIC"LIMIT $ 500,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIE i BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE VALL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Right At Home <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 /> INSn25(->mnns%m Thn Ar non and Innn of Ar npn <br />