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DocuSign Envelope ID: 1582AE24-D793-4A66-9311-4472000BOEC3 <br /> ACC>REP CERTIFICATE OF LIABILITY INSURANCE ;25/2""'"`0 '"' <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 Carla Dubuc <br /> NAME-- <br /> Sanford Insurance Center PHONE (919)775-7216 AICX. <br /> -(888)280-1697 <br /> 1722 S HORNIER BLVD E-MAIL <br /> INSURERS AFFORDING COVERAGE NAIC# <br /> SANFORD NC 27330 INSURERA:Travelers Property Casualty 0070 <br /> INSURED INSURrzRB.=WSure /Western Surety 0039 <br /> Personalized Patients Home Assistance, DBA: INSURER C: <br /> 109 Concord Dr INSURER D: <br /> INSURER E: <br /> Chapel Hill NC 27516 FINSURERF, <br /> COVERAGES CERTIFICATE NUMBERCL1472502891 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 /> IHSR TYPE OF INSURANCE POLICY NUMBER POLICY EFF PDLICY <br /> LTR EXP LIMITS <br /> GENERAL LIABILITY <br /> EACH OCCURRENCE S <br /> M <br /> COMMERCIAL GENERAL LIABILITY PR ISES E trance $ <br /> CLAIMS-MADE OCCUR VIEDEXP(A one person) $ <br /> PERSONAL&ADV INJURY $ <br /> GENERAL AGGREGATE $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ <br /> POLICY PRO- LOG $ <br /> AUTOMOBILE LIABILITY MINED SINGLE MIT <br /> Ea LI scc M <br /> ANY AUTO BODILY INJURY(Pei person) $ <br /> ALL OWNED SCHEDULED <br /> AUTOS AUTOS BODILY INJURY(Per accident) $ <br /> HIRED AUTOS NNONOSVNJED PROPERTY DAMAGE $ <br /> Per aced M <br /> $ <br /> UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ <br /> EXCESS LUIB CLAIMS-MADE AGGREGATE $ <br /> DIED RETENTION $ <br /> A WORKERS COMPENSATION WC STATU- TH- <br /> AND EMPLOYERS'LIABILITY YIN <br /> ANY PROPRIETORIPARTNERIEXFCUTIVE E.LEACHACCIDENT $ 100000 <br /> OFFICER/MEMBER EXCLUDED? NIA <br /> (Mandatory in NH) 6JUB-285564-4-14 /23/2014 /23/2015 E L.DISEASE-EA EMPLOYEE $ 106000 <br /> If yea,dearrihe under <br /> DESCRIPTION OF OPERATIONS Belau E.L.DISEASE-POLICY LIMIT S 500000 <br /> $ Dishonesty Bond 1580795 8/16/2014 8/18/2015 $80Q0. . [1 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,It more space is mquhmd) <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 DSS ACCORDANCE WITH THE POLICY PROVISIONS. <br /> PO Boix 8181 <br /> Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE <br /> S. Insurance Ce/CARIA <br /> ACORD 25(2010105) ©19138-2010 ACORD CORPORATION. All rights reserved. <br /> INS025tnrinns)ni Tho Ar_[SR[l name anti Inn^am mnia}ptwti ma'ira^f AnnRn <br />