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DocuSign Envelope ID: D40ODC89-B8BF-484E-8158-24FOOA82920D <br /> Client#:506811 20DUKEUNI <br /> DATE JMMIDDIYYYY) <br /> ACORD. CERTIFICATE OF LIABILITY INSURANCE 711312015 <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(les)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 Beth Wilkerson <br /> NAME: <br /> BB&T Insurance Services, Inc. PHDHE E,,): IC 919 281-4500 Ale,No 888-746-8761 <br /> A!C No <br /> Past Office Box 13941 n DRESS: bcwilkerson @bbandt.com <br /> Durham,NC 27709 INSURER(S)AFFOROING COVERAGE NAIC# <br /> 919 281-4500 INSURER A;Midwest Employers Casualty Comp 23612 <br /> INSURED INSURER B: <br /> Duke University <br /> INSURER C <br /> Box 104143 <br /> INSURER D: <br /> Durham, NC 27708 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 CONTRACTOR 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 /> LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER IAfOMMDNY F MhUDpY EXP LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ <br /> CO!IMERCIAL GENERAL LIABILITY PR M15ES EaE rrence $ <br /> _ CLAIMS-NIADE E1 OCCUR MEO FXP(Any one person) $ <br /> PERSONAL&ADV INJURY $ <br /> GENERAL AGGREGATE $ <br /> GENL AGGREGATE LIMIT APPLIES PER; PRODUCTS-COMPIOPAGG $ <br /> POLICY PRO- LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LI61fT <br /> Ea acddant <br /> ANY AUTO <br /> 80DILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED 130DILY INJURY(Per acddent) $ <br /> AUTOS AUTOS <br /> NON-OWNED PROPERTY DAMAGE $ <br /> HIRED AUTOS H AUTOS Peracddent <br /> S <br /> UMBRELLA LIAR HOOCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-A(ADE AGGREGATE $ <br /> DED RETENTION S $ <br /> A %YORKERS COMPENSATION EWC005735 110112014 011011201 TORYLI IT OTFf- <br /> AND EMPLOYERS'LIABILITY YIN <br /> ANY PROPRIETORIPARTNER;EXECUTfVE E.L.EACH ACCIDENT $ <br /> OFFICER!l.IEMREREXCLUDED? NIA <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under E.L.DISEASE-POLICY LI0.9€T $ <br /> DESCRIPTION OF OPERATIONS be:oN <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) <br /> RE: Duke Homecare and Hospice <br /> "Workers Comp Information** <br /> Excess WC(Lmt#11Ded#1--Each Accident; Lmt#21Ded#2-Each Emp for Disease)INC Lmt-Statutory Lmt-Statutory <br /> Deductible#1-750,000; Deductible#2-750,000 <br /> (See Attached Descriptions) <br /> CERTIFICATE HOLDER CANCELLATION <br /> Orange Count Government SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> 200 S Cameron Street ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Hillsborough, NC 27278 <br /> AUTHORIZED REPRESENTATIVE <br /> OO 1-988-2010 ACORD CORPORATION.All rights reserved. <br /> ACORD 25(2010105) 1 of 2 The ACORD name and logo are registered marks of ACORD <br /> #S144818441M11954805 BG3 <br />