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DocuSign Envelope ID:90C1 B51 E-E878-48138-13980-2C934FC73BAD <br /> HAPPHOM-01 JNEWTON <br /> CERTIFICATE OF LIABILITY INSURANCE <br /> DATE 26/2DlYYYY) <br /> s�zsi2al s <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,subjectto <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 _NAME:CONTACT Jennifer S. Newton _ <br /> The Harper Agency,Lester-Insurance Group Inc. PHONE $3fi 227-4271 (A IC,PO Box 1867 lnrc Ne E:ts: y..._.. ( Ic Nol: <br /> E-MAIL <br /> 1037 S.Main Street ADDRESS:.__ ____ <br /> Burlington,NC 27216 _ INSURER(SI AFFORDING COVERAGE _ NAIC N <br /> INSURER A:ProAssurance Specialty Insurance Co. <br /> INSURED INSURER 0: <br /> Happy Homecare Staffing,Inc. INSURER c <br /> 6720 Pentecost Rd. INSURER D <br /> Cedar Grove,NC 27231 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 PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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 /> - -ADDL SUER " POLICY EFF POLICY EXP <br /> INSR TYPE OF INSURANCE INSD WYD POLICY NUMBER MMlODfYYYY MMlOD/YYYY LIMITS <br /> LTR <br /> A X COMMERCIAL GENE EACH OCCURRENCE $ ,aaa,OD <br /> � LYAM�FTSRENTED <br /> CLAIMS-MADE ^J OCCUR AFC9520615 03!95!2015 03/1512016 PREMISES[Ea occurrence) $ 50,00 <br /> MED EXP(Any one person) $ 5,00 <br /> _PERSONAL&ADV INJURY $ 1,000,00 <br /> GEN'L AGGREGATE LIMIT APPLIESPER. _GENERAL AGGREGATE $ 2,000,00 <br /> PRO- PRODUCTS-COMPIOP AGG $ <br /> POLICY F_JECT LDC "--- <br /> OTHER PROFESSIONAL LI $ 1,000,00 <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> (Ea acodent) ___„ ,_ <br /> ANY AUTO <br /> BODILY INJURY(Per person) $ <br /> _ I -- -- <br /> ALL OWNED _ 7 SCHEDULEC BODILY INJURY(Per acddemt $ <br /> AUTOS —....:AUTOS NON-OANED PROPERTY DAMAGE $ <br /> HIRED AUTOS AUTOS Per acmdent) <br /> $ <br /> ;UMBREIL-LA LIAR OCCUR _F.AGH OCCURRENCE_ S <br /> ESSLIAB CLAIMS-MAO - AGGREGATE $ <br /> DED=RETENTION$ $ <br /> -WORKERS COMPENSATION PER OTF�- <br /> STATUTE ER _ <br /> AND EMPLOYERS'LIABILITY YIN `-A <br /> :ANY PROPREETORIPARTNERIEXECUTIVE ❑ NIA E.L.EACH ACCIDENT <br /> DFFICERIMEMBER EXCLUDED? EL DISEASE-EA EMPLOYEE $ <br /> (Mandatory in NHI _.",_ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L,DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS I LOCATIONS!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 /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Orange County Social Services ACCORDANCE WITH THE POLICY PROVISIONS. <br /> PO Box 8181 <br /> Hillsborough,NC 27278 <br /> AUTHORIZED REPRESENTATIVE/ <br /> pp Q 1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD <br />