2014-392 DSS - Premier Home Health Care Services, Inc. to perform in-home health services $415,647

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CERTIFICATE OF LIABILITY INSURANCE F711412'014 DATE IYYYV) ACORQ 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 endorsements. CONT CT PRODUCER NAME: Margie Lagazon Miller&Miller Insurance Agency Inc PHONE 4_ _ n/c Nc: 4- - 720 Commerce Street -MAIL Thornwood NY 10594 ADDREss: i - INSURER S AFFORDING COVERAGE NAIC# INSURER Aftiladelphia Indemnity Ins 18058 INSURED PREM I-4 INSURER B:Nat onal Continental Ins 10243 Premier Home Health Care Services Inc INSURER C:Homeland Ins Co of Delaware 445 Hamilton Avenue, 10th FI INSURER D:Ironshore Specialty White Plains NY 10601 INSURER E:Travelers In I demnity m n INSURER F COVERAGES CERTIFICATE NUMBER:1336795647 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 rypE OF INSURANCE A POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER MM/DD/VYYY MM/DD/YYYY LIMITS A GENERAL LIABILITY PHPK1128001 2/2014 /2/2015 EACH OCCURRENCE $1,000,000_ DAMAGE RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $100,000 CLAIMS-MADE 1XI OCCUR MED EXP(Any one person) $5,000 X Prof-Claims Made PERSONAL&ADV INJURY $1,000,000 X Sexual Abuse GENERAL AGGREGATE $3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $3,000,000 POLICY PRO- LOC $COMBINED SINGLE LIMI I B AUTOMOBILE LIABILITY CNY00070829934 /2/2014 /2/2015 Ea accident 1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ X- AUTOS X NON-OWNED PP P.E.RTY DAMAGE $ HIREDAUTOS AUTOS A X UMBRELLA LIAR X OCCUR PHUB448267 /2/2014 /2/2015 EACH OCCURRENCE $20,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $20,000,000 _ DED X RETENTION$10,000 $ E WORKERS COMPENSATION C20UB1006A37214 /30/2014 /30/2015 we srIMIT ER TORY AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE❑ NIA E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE0$1,000,000 If es,describeunder DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 D Excess Liability 001913800 2/2014 2/2015 Limit $5,000,000 C Employee Theft ML0325414 8/2014 /8/2015 Limit $50,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) *Policies shown are subject to terms,conditions,exclusions,sublimits and deductibles not listed on this certificate. We recommend that requests for policy copies be directed to the Named Insured shown above.* CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Orange County Department on Aging ACCORDANCE WITH THE POLICY PROVISIONS. 2551 Homestead Road 33// Chapel Hill NC 27516 AUTHORIZED RE .MESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD