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DocuSign Envelope ID: FCE3F262-3C43-41 138-130137-AE5E968413477 <br /> ® DATE IMWDDNYYY) <br /> ACORD CERTIFICATE OF LIABILITY INSURANCE 7114/2015 <br /> SWI <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 <br /> CONTACT George Stevens _ <br /> AX <br /> George Stevens =E.m 9194033611 ; C.No: 1 403 <br /> George Stevens Insurance Agency a DRESS: <br /> 1320 HILL STREET INSURERS AFFORDING COVERAGE NAICi! <br /> DURHAM NC, 27707 INSURERA: Mstern VV Ad In-surancP CD <br /> INSURED INSURER B: <br /> Vantage Care& Staffing, L L C INSURER C: W. <br /> 1112 Pebble Creek Crossing INSURER D: <br /> Durham, NC 27713 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 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 TYPE OF INSURANCE ADOL 5 POLICY NUMBER/ MMf IONYW MIAfDCurm EXP <br /> i - LIMITS <br /> LTR <br /> GENERAL LIABILITY EACH OCCURRENCE s 1,000,000 <br /> A LAJJD-K 7/2/2015 71212016 A TO RENTED <br /> rI COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ <br /> ❑ ❑ CLAIMS-MADE rw]OCCUR MED !XP(Any one person) S 5.000 <br /> PERSONAL&ADV INJURY $ <br /> GENERAL AGGREGATE $ 2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER, PRODUCTS-COMPIOP AGG $ Inclucipri <br /> —� _ <br /> POLICY PRO LDC $ <br /> COMBINED SINGLE LIMIT <br /> AUTOMOBILE LIABILITY (Ea aCCIQBMI <br /> .ANY AUTO BODILY INJURY(Per person) $ <br /> ALLOWNED SCHEDULED BODILY INJURY(Per accident), $ <br /> AUTOS AUTOS <br /> /JON-OWNED PeOr acciden DAMAGE $ <br /> HIREDAUTOS — AUTOS <br /> $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAR CLAIMS-MADE �AGGREGATE S <br /> DED RETENTION$ S <br /> WORKERS COMPENSATION -- WC STATU I OTH- <br /> AND EMPLOYERS'LUIBILITY YIN <br /> ANY PROPRIETOR1PAR7NERlEXECUTIVE❑ NIA. E.L.EACH ACCIDENT $ <br /> OFFICFRIMEMBER EXCLUDED? <br /> (Mandatary in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS f LOCATIONS f VEHICLE$ (Attach ACORD 101,Additional Renarks Schedule,if mare space is required) <br /> Sexual Abuse and Molestation Liability$25,000 per occurrence$50,000 aggregate <br /> CERTIFICATE HOLDER CANCELLATION <br /> Orange County Social Services SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> 113 Mayo Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Hillsborough, NC ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> ©1968-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 26(2010105) The ACORD name and logo are registered marks of ACORD <br />