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DocuSign Envelope ID: E159BACB-CB73-4DED-B2AA-303FCC337EC5 <br /> CARESHA-01 PIKSHI <br /> DATE(M M/DD/YYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE 3/17/2015 <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 <br /> NAME: <br /> IAS Associates,LLC aHONNo Ext:(919)277-1330 A/C,No):(919)287-2995 <br /> 5001 Weston Parkway Suite 105 E-MAIL <br /> Cary,NC 27513 ADDRESS: <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A:Hartford Casualty Ins CO 29424 <br /> INSURED INSURER B: I <br /> Care Share Health Alliance INSURER C: <br /> 100 Regency Forest Drive, Suite 200 INSURER D: <br /> Cary,NC 27518 INSURERE: <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 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS <br /> LTR INSD WVD POLICY NUMBER MMIDDIYYYY MMIDD/YYYY <br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 <br /> DAMA(31 1-0 IN 110 <br /> CLAIMS-MADE [XI OCCUR 22SBAVH1035 0810412014 0810412015 PREMISES Ea occurrence $ 300,000 <br /> MED EXP(Any one person) $ 10,000 <br /> PERSONAL&ADV INJURY $ 2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 <br /> X POLICY❑JECT <br /> PRO- ❑ LOC PRODUCTS-COMP/OP AGG $ 4,000,000 <br /> OTHER: HNOA $ 2,000,000 <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ''.. <br /> Ea accident <br /> ANY AUTO BODI LY I NJU RY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ '. <br /> AUTOS AUTOS <br /> NON-OWNED PROPERTY DAMAGE $ <br /> HIREDAUTOS AUTOS Per accident <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ I. <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION <br /> AND EMPLOYERS'LIABILITY y/N AND EERH <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? ❑ N/A <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 /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Orange County ECOnOmIC Development THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> 9 tY ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 131 W Margaret Lane,Suite 205 <br /> Hillsborough,NC 27278 <br /> AUTHORIZED REPRESENTATIVE !. <br /> fx-✓'d lea--�..� <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br />