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

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f ,d►coR CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 2/1/2016 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 on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Margie Laaazon Miller&Miller Insurance Agency Inc PHONE _ _ N01:914-741-6407 720 Commerce Street E-MAIL Thomwood NY 10594 ADDRE - INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:EVANSTON INS CO 35378 INSURED PREM I-4 INSURER B: 4 Premier Home Health Care Services Inc INSURER C: 445 Hamilton Avenue, 10th FI INSURER D:CHARTER OAK FIRE INS CO 5615 White Plains NY 10601 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER:649789696 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD LIMITS A GENERAL LIABILITY SM912000 2/2/2016 202017 EACH OCCURRENCE $1,000,000 PX COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 8100,000 CLAIMS-MADE �OCCUR MED EXP An one person)__ $5,000 Pro f-Claims Made PERSONAL&ADV INJURY $1,000,000 X Sexual Abuse GENERAL AGGREGATE $3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $3,000,000 POLICY PRO LOC 1 1 $ B AUTOMOBILE LIABILITY CNY00070829935 2/212016 2/212017 Ea accident) $1,000,000 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 5-10035 2/2/2016 2/2/2017 EACH OCCURRENCE $25,000,000 X EXCESS LIAR CLAIMS-MADE AGGREGATE $25,000,000 DIED I X I RETENTION$10.000 $ D WORKERS COMPENSATION TC20UB1006A37215 6/30/2015 6/30/2016 X VVC STATU- OTH- E AND EMPLOYERS LIABILITY YIN TRKUB36124A49615 6/30/2015 6/30/2016 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $1,00 000 If yes,describe under --�---- - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$1,000,000 F Employee Theft UC2118450516 2/8/2016 2/812017 Limit $50,000 DESCRIPTION OF OPERATIONS/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 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 RATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD