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DocuSign Envelope ID: 1582AE24-D793-4A66-9311-4472000BOEC3 <br /> UtliJ/2J1b 1'L:2J I�1jy2jubuj PPHA PAGE 03/03 <br /> .;l 0 l CERTIFICATE OF LIABILITY INSURANCE GATE{Igmmoy" <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF{NFDRN4A"Fl4N ONLY AND CQNFERS NO RIGHTS UPON THE CERTIFICATE H�O DER TH13 <br /> CEfMFICATE DOES NOT AFFIRMATIVELY OR NEGATIIVELY AMEND, EXTEN13 OR ALTS THE COVERAGE AFFORDED t3Y THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INS�IRtIs1, AuniOt31Z$1] <br /> Rl=PR1=5ENTATIVE OR PRODUCER,ANO THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the Csrtiflaatg holder is an Appl}7ONA1 INSURED, the pollay(Iss!must K1e er1 @nrs0d. It SUBROGATION IS WAiVEIJ,subject to <br /> the terms and ar in 1m i r of the policy,ok+rtalrl policies may rage�lre an endorsement. A statement on this oertmeatr�dogs not Crfnfer rights a the <br /> cerlmprt9 htllCter!!I Iies1 of 5ueh an s1, <br /> PRODULM Hanover Excess,&SurpluS, lflC. NAME: <br /> PO Box 12450 PHONE — <br /> Ars <br /> WI LM INGTON, NC 28405 4r�IF�s: jnr ra:�^ <br /> _ IIHRURER{SI AvroaDrNO COVET <br /> msurt>o INSIJRFRA: SCOT780ALE INSURANCE COMPANY X11297 � <br /> PERSONALIZED PATIENTS HOME ASSISTANCE rr�suRERe; <br /> DOROTHEA FARRINGTON DBA <br /> 109 CONCORD DRJV�j Imo <br /> rFIS�IwR D; <br /> CHAPEL.HIM, NC 27518 INSUR�Rr <br /> COVERAGES CERTIFICATE NUIMall INrt;t,rREIRF <br /> TH13 A Tb CERTIFY THAT THi= 51 PANYC ' OF .IEMENT.CE IM OR Q NDII HAVE 8€>N ISSUED T(?TtiE iNSUp D RE IIISION NAkIEp ABCAr NUMBER.QR THE POLICY AERIOD <br /> INDICATED, NOTtrUrTHSTSUED O ANY REQUIREMFrWT,TERM OR CCkVDITlDN OF ANY CONTRACT OR OT14ER DOCUMr;NT WITH i2f;SP @C7 1154 JCY WHICH THIS <br /> QD <br /> CI=>ZIIFICASTE MAY BE ISSUED OR MAY Pi=HTAW, TF{E iNSEJRANCE AFFORDED BY THE POL CM OESCt#IDED Hi<RE�+J rs WITH RG7 TO ALL THE TERMS, <br /> FJCCLUSIONgAN}7 CONDITIONS OF SUCH POLiCri;s.Lill SHOWN MAIYHAVF_B€EN R!4UGFp BY PAID CIAIMS, <br /> TYPEl7FIN3URANCEO F AL <br /> X commr=RCIAL k-PNERAL LIABILrtY PaLrcY NlrtuIBER ra <br /> LrMITs <br /> A CLMMS-I ADe D OCCUR I MCl1 OCCURRFJNCF � 1,U00,000 <br /> CPS2030182 d7/2QT2D94 97/2V2015 EUisF Edon rmnco 3 100,000 <br /> —�� <br /> `Ar-D LXP(An ono ernonl f 5,000 <br /> II oRFGATe1."M-+PPLIESPER: PIIRSONAL&/ti0V1NJI,IRY S 1,0QQ0QQ <br /> X POLICY Mr El Loc GENERAL AGGRECATF R 2000,000 <br /> OTHER: PRODUln/OpAGG a 2,Q00 040 <br /> AL1'rgMa5l LlAWLrry ? <br /> ANY AUTO COM IN SrN-Lt LI <br /> o occldyntl _� - <br /> - ALT,OS NFp _ RaUCTHUES AuTa NON-OOM <br /> E6 I"REDAl AUT08 fS4O0OII,Y Y INJURY tfpPearrpce!skooryn}k <br /> } $ — <br /> erecGtlenr $ � � <br /> UMBRELLA uAS OCCUR <br /> k7iCPSOLIAe CLINMrrwor, EAC11 OCC,1RRII g <br /> Cea RETENrnN. AGGRI=GATE k <br /> wor�kelas CaNn�ysaTtON <br /> AND EMPLOYM'LIAil <br /> ANY PRCPRIE70RPARTNE04J TlvE YIN ps? <br /> 0FFICEP1MLMRMZxCLUO4a7 III R <br /> (Manderory In MR) E.L.E4CH Cl AC deaalay <br /> -OP <br /> nxSC'RrP1'ION OF'OPMTIQNS nolow E.L.DISFAS�-FJl EMkOYE 3 _ <br /> A SEXUAI,ANil PHYSiC CP82033182 E.L.01 -POLICY 4IMrr <br /> ABUSE COVERAGE © l b- <br /> 31 o-�-- 0 <br /> bEgCRrPT74N OF OPBtA"R4hL4!I,gCAT10N5!vEHICL88 co IRI�D 101,Addlrrnnal I�++menca aeheduro,may de alh,chetl N morn■pees Is roglelred) <br /> CERTIFICATE HOLJDER <br /> GRANGE COUNTY l CANCELLATION <br /> PO BOX 8181 SHOULDAHY OF TKr;ABOVE pkBCRIOPO POUCIE 1 es eAlaaPr 1.nD aIEPCUtrw <br /> HILLSBOROUGH, NO 27278 Tl ZXIO1111 ON DATE THEII NOTICE YMB A DELnIERI}o IH <br /> ACCORDANCE wIIH Til POLICY PROVIaIONS; <br /> AUf1'!ORlXED REPrEryrgT <br /> '`CORD 28(2014101) The ACORD 011988-210114 AWRD CORPORATION.and logo bra rFfgrstered marks of ACORD N' A1I rFghts reserved. <br />