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1 ® DATE(MMIDDNM) <br /> A4C"R CERTIFICATE OF LIABILITY INSURANCE 08/13/2014 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, <br /> THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE <br /> AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN <br /> THE ISSUING INSURER(S),AUTHORIZED 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, <br /> subjectto the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does <br /> not confer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT <br /> NAME:Trust Risk Management Services,Inc <br /> PHONE FAX <br /> Trust;Risk Management Services,Inc,doing business in NC as Potomac a1C,No,Ext:877.637.9700 LAIC,No)-.877.251.6111 <br /> Risk Management Services,Inc. EMAIL <br /> 1791 Paysphere Circle ADDRESS:in INSURER 5 AFFORDING COVERAGE NAIG4 <br /> Chicago,IL 60674 INSURER A.ACE American Insurance Company 22667 <br /> INSURED INSURER B: <br /> MICHAEL J CLITTLER INSURER C: <br /> 3409 W Wendover Ave Ste A INSURER D: <br /> Greensboro,NC 27407 1579 INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 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 <br /> PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT <br /> TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT <br /> TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR - ADDL SUB POLICY EFF POLICY EXP <br /> LTR TYPEOFINSURANCE INSR tNVD POLICYNUMBER (MMIDD/YVYY) (MMIDDIYYYY) LIMITS <br /> COMMERCIAL GENERAL ABILITY EACH OCCURRENCE $ <br /> DAMAGE To RENTED $ <br /> CLAIMS MADE <br /> OCCUR PREMISES(Ea occurrence) <br /> MED EXP(Any one person) <br /> PERSONAL&ADV INJURY $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ <br /> C LOC <br /> POLICY �JET ❑ <br /> PRODUCTS-COMPiOP AGO $ <br /> OTHER: <br /> AUTOMOBILE LIABILITY (Ea SINGLE LIMIT IT <br /> Ea accident <br /> ANYAUTO BODILY INJURY(Per Person) $ <br /> ALL OWNED SCHEDULED $ <br /> AUTOS AUTOS BODILY INJURY(Per acdden <br /> HIRED AUTOS AUTp6ED PROPERTY DAMAGE $ <br /> (Per dent) <br /> $ <br /> UMBRELLA LUIB OCCUR EACH OCCURRENCE $ <br /> EXCESS UAB CLAIMS-MADE AGGREGATE <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION IPER OTH $ <br /> AND EMPLOYERS LIABILITY YIN LITE I ER <br /> ANY PROPRIETORIPARTNERIEXECUTIVE N/A E.LEACH ACCIDENT $ <br /> OFFICERIMEMBER EXCLUDED? ❑ $ <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYE <br /> Ifyes,describe under F.L.DISEASE�POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS below <br /> Psychologist's Professional 78622104160 10/01/2014 10/01/2015 Each Incident $2,000,000 <br /> A Liability Annual $4,000,000 <br /> Retroactive Date:10/01/1991 Aggregate <br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space Is required): <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED <br /> BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE <br /> DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> ACORD 25(2014101) ©1988-2014 ACORD CORPORATION.All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />