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DocuSign Envelope ID:89EE68A1-29FA-417C-9C6F-034CDOD2C779 <br /> a DATE(MMIDDIYYYY) <br /> ACOR" CERTIFICATE OF LIABILITY INSURANCE <br /> 413!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 NAME: <br /> SilverStone GroupPHONE 2 - 501 FAAX No: - - 7 <br /> 11516 Miracle Hills Drive E-MAIL SS:home r i <br /> Suite 100 <br /> Omaha NE 68154 INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A:Phil d I CompaDy 23850 <br /> INSURED 14508 INSURER B: <br /> KAH Care LLC INSURER C: <br /> Right at Home INSURER D <br /> 4905 Pine Cone Drive Suite 2 <br /> Durham NC 27707 INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:983697408 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 ADDLISUBR POLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE D POLICY NUMBER MMIDDIY MMIDD LIMITS <br /> A GENERAL LIABILITY PHPK1283261 1612015 /16/2016 EACH OCCURRENCE $1,000,000 <br /> DAMA <br /> X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $1,000,000 <br /> CLAIMS-MADE KI OCCUR MED EXP(Any one person) $20,000 <br /> PERSONAL&ADV INJURY $1,000,000 <br /> GENERAL AGGREGATE $3,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG $3,000,000 <br /> X POLICY PRO LOC I $ <br /> A AUTOMOBILE LIABILITY PHPK1283261 !1612015 116!2016 Ea accident 1,000,000 <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED <br /> AUTO S AUTOS BODILY INJURY(Per accident) $ <br /> X HIRED AUTOS X AUTOS Per Oacci e <br /> dntDAMAGE $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED I I RETENTION$ $ <br /> WORKERS COMPENSATION WC STATU- OTH- <br /> AND EMPLOYERS'LIABILITY YIN TORY <br /> ANY PROPRIETORIPARTNERIEXECUTIVE❑ E.L.EACH ACCIDENT $ <br /> OFFICERIMEMBER EXCLUDED? NIA <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 5 <br /> A Crime PHPK1283261 116/2015 116/2016 Limit 25,000 <br /> Professional Liability Limit 1 M 13M <br /> Property Limit 25,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,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 /> Proof of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD <br />