2015-409 DSS - Premier Home Health Services, Inc. to provide employees to perform in home aide service to OC clients $415,647

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® CERTIFICATE OF LIABILITY INSURANCE DATE(MMA)DIYYYY) ,4CORO 6/26/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy((es)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemen s. CONTACT PRODUCER NAME: Margie Lagazon Miller&Miller Insurance Agency Inc PHONE _ _ FAX AIC No 720 Commerce Street E-MAIL Thornwood NY 10594 ADDRESS: INSURERS)AFFORDING COVERAGE NAIC 8 INSURER A:Natffional Continental Ins 10243 INSURED PREMI-4 INSURER BLEXINGTON INS CO 19437 Premier Home Health Care Services Inc INSURER C:LEXINGTON INS CO 19437 445 Hamilton Avenue, 10th Fl INSURER D:Hiscox Insurance In White Plains NY 10601 INSURER E:The Charter Oak Fire Ins CO 25615. INSURER F COVERAGES CERTIFICATE NUMBER:25902848 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER IMMIDDNYYY MMIDDIYYYY B GENERAL LIABILITY 6797950 2/2/2015 212/2016 EACH OCCURRENCE $1,000,000 DAMAGE T REN X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $100,000 CLAIMS-MADE FTI OCCUR MED EXP(Any one person) $5,000 X Prof-Claims Made PERSONAL&ADV INJURY $1,000,000 X Sexual Abuse GENERAL AGGREGATE $3,000,000 GEhrL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $3,000,000 POLICY PRO- LO C $ A AUTOMOBILE LIABILITY CNY00070829935 212!2015 212/2016 Ea accident) $1,0D0,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Per accident C UMBRELLA LIAB X OCCUR 6797951 2/2/2015 2/2/2016 EACH OCCURRENCE $25,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $25,000,000 DIED I X I RETENTION$10,000 $ E WORKERS COMPENSATION TC20U61006A37215 6/30/2015 6/30/2016 X WcYrATU- OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? F N IA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 H es,describ under DESCRIPTION e OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000 000 D Employee Theft UC2118450515 2/8/2015 2/8/2016 Limit $50,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,K more space is required) *Policies shown are subject to terms,conditions,exclusions,sublimits and deductibles not listed on this certificate. We recommend that requests for policy copies be directed to the Named Insured shown above.* CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Orange County Department of Social Services ACCORDANCE WITH THE POLICY PROVISIONS. 113 Mayo Street Hillsborough NC 27278 AUTHORIZED RE ESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD