2015-524-E Health - Mental Health America of the Triangle

Browse Search

DocuSign Envelope ID:24392949-6CFE-4A47-8FC6-54FF2C794193 ® DATE(MMIODIYYVY) ,4 r� CERTIFICATE OF LIABILITY INSURANCE 11J6/2014 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(ies) must be endorsed. If SUBROGATION i5 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 endorsement(s). CONTACT Diana Mausling PRODUCER NAME: B1151riesS Insurers of Carolinas PHONi {919)968-4611 fAJC (91919fi6^SS91 AIC Mali- 800 Eastowne Drive, Suite 208 AoaIL _dmausling @Business-Tnsurers.com PO Box 2536 INSURE S)AFFORDING COVERAGE NAIC11 Chapel Hill NC 27515-2536 INSURERA:Continental Western Ins Company 10804 INSURED INSURER B:The Hartford 29424 Mental Health_ America of the Triangle INSURERC: PO Box 16246 INSURER D INSURER E: Chapel Hill NC 27516 INSURER F COVERAGES CERTIFICATE NUMBER:CD1411611709 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. Xff5UVU8R POLICY EFF POLICY EXF LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A E N ED 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence S A CLAIMS-MADE OCCUR PA422752044 1/22/2014 1/22/2015 MEDEXP(Any one person) S 20,000 X Professional Liabillty PERSONAL&ADV INJURY $ 1,000,000 X AbUse or Molestation GENERAL AGGREGATE S 3,000,000 GENT AGGREGATE LIMIT APPLIES PER, PRODUCTS-COMPIOP AGG $ 3,000,000 X POLICY PRO- S LOC COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY fEa accident $ BODILY INJURY(Per person) S A ANY AUTO ALL OWNED SCHEDULED PA422752044 1/22/2014 1/22/2015 BODILY INJURY(Per accident) S AUTOS AUTOS PROPERTY DAMAGE X HIRED AUTOS X AUOTOSWNED Per accident S H&NO 5 l 009 000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UA6 CLAIMS-MADE AGGREGATE $ $ DEO RETENTION S A WORKERS COMPENSATION wC STA IT ER X RY I 17 X AND EMPLOYERS'LIABILITY ANY PROPR ETORIPARTNERIEXECUTIVE Y� E.L.EACH ACCIDENT 5 5OO OQO OFFICERIMEABER EXCLUDED? N NIA CA422752144 11/22/2014 1/22/2015 E L DISEASE-EA EMPLOYEE 5 500,000 (Mandatory in NH) Ifyes,describe under E.L-DISEASE-POLICY LIMIT S 500,00o DESCRIPTION OF OPERATIONS below 13 Directors & Officers aOA1308922 /20/2014 /2012015 PelClalrn $1,000,000 Deductible $2,500 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, Mental Health America of the Triangle PO BOX 16246 AUTHORIZED REPRESENTATIVE Chapel Hill, NC 27516 Tarred Chappell/DIANA OO 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) --- - --�-- A—s Arnon