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DocuSign Envelope ID:4n0Ce831-88Eu-408B-8r1n~^r1C30u3n3*4 <br /> Client#: 955852 04SEmKOCAR1 <br /> ACORD= CERTIFICATE OF LIABILITY INSURANCE DATE(MM/nD/Yr n <br /> ' <br /> O7/1W2416 <br /> TillS 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 /> BB&T Insurance Services, Inc. PHONE 888 743-2217 °°.w*.888V%7g881 <br /> 414 Gallimore Dairy Road E-MAIL <br /> ADDRESS:��~�__ <br /> Suite INSURER(S)AFFORDING COVERAGE NAIC» <br /> Greensboro, NC 37409 ����^.Evanaton|nsurancoCnmpany 35378 <br /> INSURED --- --- --- --- -- �i��po,�|nmu,enoe���`pany ---- 36684 <br /> ���!"a. <br /> Senior Care of Orange County Inc <br /> INSURER C; __ <br /> Attn Day Health Cent <br /> INSURER o.____ <br /> 105 Meadowland Dr. <br /> INSURER s. <br /> Hillsborough, NC 27270'0181 <br /> INSURER,. --- <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 rEwmo, <br /> EXCLUSIONS AND SUCH POLICIES. LIMITS SHOWN MAY REDUCED o, pmo CLAIMS. <br /> ___ <br /> pSvr--- -------' ---�v�Svam' ------- u�� <br /> LTR �Psm,woun^pCE /NmamVD POLICY M�mo�'v` MMme, , <br /> A COMMERCIAL SM914951 `+7/1�/�V1� 07/1�/2V1 EACH� OCCURRENCE <br /> X CLAIMS-MADE � OCCUR B���_� �� $50�oo <br /> ) |gyPuDed:5.V00 MED EXp(Any one person) l$5,000 <br /> pExS�A.ummINJURY $1,000,000 <br /> srwL^oencamcum�mppussPER; , GENERAL AGGREGATE $3.00�000 <br /> ..... <br /> PRO- <br /> _ <br /> pnucr mn pnoouCTI-cm*pmp^GG $ <br /> � <br /> OTHER: <br /> --- --- — --- --- --- SINGLE ��� <br /> AUTOMOBILE LIABILITY � 'r^aymeno » <br /> ANY AUTO / EDGILY INJURY(Per person) $ <br /> 1 ALL OWNED i I SCHEDULED accident) 5 _______ <br /> AUTOS AUTOS <br /> HIRED AUTOS | NON-OWNED PROPERTY DAMAGE p_AUTOS <br /> s <br /> UMBRELLA ��N OCCUR EACH OCCURRENCE <br /> — | <br /> EXCESS u�� CLAIMS-MADE � AGGREGATE <br /> _ <br /> --� , |� <br /> --- ----- ---- -- . � ---- or�' --- <br /> B WORKERS COMPENSATION NCARp305328 ^2/0g0016 O2/U0201� �_���� <br /> ^wo EMPLOYERS'LIABILITY ,� | <br /> '" s'�����cposwr $500,000 <br /> /�������������[�nc��srunvs�~| u/^ � <br /> * ^ ' . c.L.o/Sc^Sr-EA EMPLOYEE $509,000_ <br /> ���"�� ERATIONS below � � E.L.DISEASE-POLICY LIMIT $500,000 <br /> A Sexual Acts SM914951 "7/13/2016 07/13Q01 $100,000 occurence <br /> Liablity $300,000 aggregate <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACOpo`o,.Additional Remarks Schedule,may be attached if more space is required) <br /> Professional Liability'Po|.#SMg14951 <br /> Professional Liability Limit#1: 1.800.000 Ded.#1: $5.000.00 <br /> Limit#2: 3,000,000 <br /> Retroactive Date:July 13, 2005 for GL and PRO <br /> (See Attached Descriptions) <br /> . <br /> CERTIFICATE CANCELLATION <br /> ` . <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> ' <br /> Senior Care o Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Attn: Day Health Center ACCORDANCE WITH THE POLICY PROVISIONS. <br /> For Information Only , <br /> 105 Meadowland Drive AUTHORIZED REPRESENTATIV <br /> Hillsborough, NC 27378'8181 �� <br /> . � _ m � <br /> @1yov-2v1*Aoono CORPORATION,All rights reserved. <br /> Acunoes(2v4/o1) 1 of 2 The ACORD name and logo are registered marks of ACORD <br /> #S16521611/M16521526 SO5 <br />