Orange County NC Website
Browse       Search
t <br /> E <br /> DocuSign Envelope ID: 7DB9202D-FDA8-426E-8A84-EAE7538E9310 <br /> / 1 ® DATE(MMIDDIYYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE <br /> 04/24/20,4 <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 endorsement(s). <br /> PRODUCER CONTACT NAME: <br /> Marsh USA Inc. <br /> 333 South 7th Street,Suite 1400 (A/C PHONE, Ext: a c No): <br /> Minneapolis,MN 55402-2400 E-MAIL <br /> Attn:Healthcare.AccountsCSS @marsh.com Fax 212-948-1307 ADDRESS: <br /> INSURERS AFFORDING COVERAGE NAIC# <br /> 401115-OLD-PL5M-14-16 INSURER A:Old Republic Insurance Company 24147 <br /> G <br /> INSURED INSURER B: <br /> UNITEDHEALTH GROUP <br /> 9900 BREN ROAD EAST MN008-W345 INSURER c: <br /> MINNETONKA,MN 55343 <br /> INSURER D: <br /> INSURER E: <br /> INSURER F. <br /> i <br /> COVERAGES CERTIFICATE NUMBER: CHI-004227576-12 REVISION NUMBER:10 <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.POLICY EXP <br /> INSR TYPE OF INSURANCE INSR SUER POLICY NUMBER MM%POLICY DNYYY <br /> LTR MMIDDNYYY LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ <br /> DAMAGE TO RENTED <br /> COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ <br /> CLAIMS-MADE E]OCCUR MED EXP(Any one person) $ <br /> PERSONAL&ADV INJURY $ <br /> GENERAL AGGREGATE $ <br /> GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ <br /> POLICY JEO LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> Ea accident <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <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 RETENTION$ $ 19 <br /> WORKERS COMPENSATION WC STATU- OTH- <br /> AND EMPLOYERS'LIABILITY YIN L S E <br /> ANY PROPRIETOR/PARTNER/EXECUTIVEâť‘ N/A <br /> E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> A Managed Care MWZZ302190 05101/2014 05/01/2016 Each Claim $5,000,000 <br /> Professional Liability/E&O RETRO DATE:111R7 Annual Aggregate $5,000,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> UNITEDHEALTH GROUP SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> 9900 BREN ROAD EAST MN008-W345 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> MINNETONKA,MN 55343 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> of Marsh USA Inc. <br /> Manashi Mukherjee <br /> ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD <br />