2016-552 Aging-DSS - Premier Home Health Services, Inc. for in-home aides services

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1 ® DATE(MWDD/YYYY) ACORO CERTIFICATE OF LIABILITY INSURANCE L8/17/2016 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(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement or#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 PHE _No,ON Na: _ 720 Commerce Street E-MAIL Thornwood NY 10594 ADDREss: - INSURER S AFFORDING COVERAGE NAIC 9 INSURER A:EVANSTON INS CO 35378 INSURED PREMI-4 INSURER B:NATIONAL CONTINENTAL 4 Premier Home Health Care Services Inc INSURER C: V Y SPECIALTY INSURANCE COMPAN 445 Hamilton Avenue, 10th FI INSURER D: Fire Ins CO White Plains NY 10601 INSURERE:HISCOX INS CO INC INSURER F:Tr velers Indemnity Company COVERAGES CERTIFICATE NUMBER:203850368 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 TYPE OF INSURANCE POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER MM/DDIYYYY MM/DD/YYYY LIMITS A GENERAL LIABILITY' SM912000 2/2/2016 2/2/2017 EACH OCCURRENCE $1,000,000 MA DA =UKLNihU x COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $100,000 CLAIMS-MADE a OCCUR MED EXP(Any one person) $5,000 X PROF-CLAIMS MADE PERSONAL&ADV INJURY $1,000,000 X SEXUALABUSE GENERAL AGGREGATE $3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $3,000,000 POLICY PRO- LOC $ B AUTOMOBILE LIABILITY CNY00070829935 2/2/2016 2/2/2017 Ea accident) $1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS NON-OWNED PROPERTY $DAMAGE X HIREDAUTOS x AUTOS Wer accident) C UMBRELLA LIAB X OCCUR 5-10035 2/2/2016 2/2/2017 EACH OCCURRENCE $25,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $25,000,000 DED I x I RETENTION$10,0 0 1 SEXUAL ABUSE $10,000,000 D WORKERS COMPENSATION TC20UB1006A37216 6/30/2016 6/30/2017 X WC STATU- OTH- F AND EMPLOYERS'LIABILITY YIN TRKUB36124A49616 6/30/2016 6/30/2017 ANY PROPRIETOR/PARTNER/EXECUTIVE❑ NIA E.L EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 E Employee Theft UC2118450516 218/2016 2/8/2017 Limit $50,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If 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 Orange County Dept of social Services THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 113 Mayo Street ACCORDANCE WITH THE POLICY PROVISIONS. Hillsborough NC 27278 AUTHORIZED RgMESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD