2015-308-E DSS - Happy Homecare Staffing, Inc. for RN services $10,000

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DocuSign Envelope ID:90C1 B51 E-E878-48B8-B980-2C934FC73BAD HAPPHOM-01 JNEWTON ACORO" F CERTIFICATE OF LIABILITY INSURANCE DATE(MMfoorrrrY) 5/28/2016 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 d. 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 endorsement(s). PRODUCER NAOMEACT Jennifer S. Newton The Harper Agency,Lester Insurance Group Inc. PHONE -- FAX PO BOX 1867 .(AJ C,.No,.E.x4].:.I33F?.22T-4ZT'I-__- WC,NO: 1037 S.Main Street ADDRESS: Burlington,NC 27216 -- - INSURER(SI AFFORDING VI IrERAGE NAIC 9 - - _.._... INSURER A:PPDASSUrance Specialty Insurance Co. ----- INSURED - - - - INSURER , Happy Homecare Staffing,Inc. INSURER c 6720 Pentecost Rd. INSURER D: _.__ -- — — Cedar Grove,INC 27231 - INSUREri.E.'._.-_-.- INSURER F c ' COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: I 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.OMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 'N99.1 .-.-...._— ------- -FDUaRI Gi ...... ..............__.._POL4Y EFF W-CYY EXP LTR TYPE OF INSURANCE INSD!riND I POLICY NUMBER MMIDDfYYYY MMID LIMITS A X coMMERCIALGENERALLIABIUTY EACH OCCURRENCE ; 1,000,0 CLAIMS-MADF X OCCUR AFC9520616 03!1512016 03/15/2016 ; 50 40 PREMISES fEa Dccurrance) --- --__--I - -_ MEDEXP(Any one person) $ 5,0 PERSONAL&ADV iNjuRY s 11000,000 GEN'LAGGREGATE LIMIT APPLIES PER' GENERAL AGGREGATE ;. - T 2,000,00 X POLICY I-- PRO - --- - . I JEC F—]T LOC PRODUCTS-COMPfOP AGG S OTHER PROFESSIONAL Li ; 7,000,04 AUTOMOBILE LIABILITY C Ea t31N IN L l $ aeGdent ANY AUTO __ BODILYINJURY(Perperson) $ yALLOWNED SCHEDULED BODILY INJURY(Per aceidenq $ AUTOS L„_, AUTOS ! NON-OWNED PROPERTY DAMAGE HIREDAUT05 AUTOS S UMBRELLA LIAR i�OCCUR EACH OCCURRENCE EXCESSLIAB CLAIMS-MADE AGGREGATE ; DEC !RETENTION 3 $ I WORKERS COMPENSATION PER ERH• i !AND EMPLOYERS'LIABILITY YIN ;STATUTE ANY E OF FICERIMEMBER EXCLUDED?ECUTwE N I A F.L.EACH ACCIDENT _ E i(Mandatory in NHi E.L,DISEASE-EA EMPLOYEE ; "-.._-..._...__. III yes,describe under D OF OPERATIONS below E,L,DISEASE-POLICY LIMIT S i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additlonal Remarlm Schedule,may be attached it more space is required) (Policy includes Sexual Misconduct Coverage-$230,000 per occurrence and$750,000 aggregate CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County Social Services THE EXPIRATION DATE THEREOF, NOTICE VALL BE DELIVERED IN Or Or Box 8161 ACCORDANCE 4111TH THE POLICY PROVISIONS. Hillsborough,NC 27278 AUTHORIZED REPRESENTATIVE 0 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD