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DocuSign Envelope ID:3D2AE91 F-A053-456D-811 F-727562AB2926
<br /> A`°R°® CERTIFICATE OF LIABILITY INSURANCE DATE IMMIDDIYYYYI
<br /> 11/14/2016
<br /> THIS 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 pollcy(tes)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 an this certificate does not confer rights to the
<br /> certificate holder in lieu of such endorsement(s),
<br /> PRODUCER `CONTACT ICriata Dean
<br /> HAM!, _.. .. ....
<br /> Altus Partners, Inc ND,EXO (610)526-9130 ,F �1;16101526-2D21
<br /> 919 Conestoga Road AUDRe66.certificatesNaltuvpertnera,corn
<br /> PRODUCER 00000042
<br /> Building 3, Suite 111 CUSTOMER ID F,
<br /> Rosemont PA 19010 PURER AFFORDING COVERAGE NAM a
<br /> INSURED INSURER A:Lloyd'a of London ;,623/623
<br /> Maxim Healthcare Services, Inc. INSURER 13 ACE American Ins Co. %:2667
<br /> d/b/a Maxim Staffing Solutions INSURER LACE American Ins Co, :2667
<br /> 7227 Loci DeForest Drive I
<br /> Columbia MD 2.1046 I
<br /> INSURER!:
<br /> INSURER.F I......................
<br /> COVERAGES CERTIFICATE NUMBER:16-17 Staffing 9td REVISION NUMBER:
<br /> THIS IS TO CERTIFY THAT THE POu CITES 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 TERMS,
<br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> ?T. TYPE O....F INSURANCE ......�...._....,..1114511.i8 MID __.._ ,P,9,. 9Y_MMO ? ..... ..,_ Mpp Y OG EXP.....__ "" ._._.,._,.«....,..,......_,....,..
<br /> WAITS
<br /> GENERAL UAOIUTY OCCU EACH -..---
<br /> I OCCURRENCE f 10,000,DUO..
<br /> r]./30/2016 1/30/2017 DAMAGE TO RENTED q,p00,DOD
<br /> X COMMERGENERAL AL GENEAl 4NT u4 ITY H1605784 PREIMSES(Ea eocumm�ce) S
<br /> A . X i CLAIMS-MADE N OCCUR MEC EAPAnyono eon,..... $ 10,000.
<br /> X Professional Liab PERSONAL 6AOV INJURY S Include
<br /> X_.. r1,000,000_., 0
<br /> GEM AGGREGAE Mar APPLIES PER roduc6a ,PRODUCTS OCOV.r+J(W AGG S 10,000,000
<br /> �I 'xolusson ,s
<br /> AUTOMOBILE UADI 71'8i tOC
<br /> ,. 109051600 9 594 IOwnedT �.1f 30/2016 a 1/3012017 CgMBYYED SRYIP, seen
<br /> UTY {EtACddemy I S 1,000,000
<br /> X ANY AUTO 09051594 (KENO) x1/30/201611/30/2017 ..
<br /> BODILY INJURY I�Penonl i
<br /> B ALL DWNI,CI AUTOS' BOORT INJURY IPer Amami) S _ ...
<br /> SCHEDULED AUTOS PROPERTY DAMAGE
<br /> f
<br /> X HIREO AUTOS' !Per Aad 1oW
<br /> X NON-OWNED AUTOS I UAANufeA AN0Iorist[apnea f
<br /> Uru:enulw 00 intone $
<br /> I.
<br /> UMBRELLA LIAO J OCCUR EACH OCCURRENCE f
<br /> —
<br /> EXCESS LIAfl CLAIMS..MADE AGGREGATE f
<br /> DEDUCTIBLE f
<br /> ..... I
<br /> ,RETENTION S S
<br /> L. WORKERS DOMPEN'SABON x49105204 11/30/2016 1/30/2017 y"_TORYSTATU iI ER
<br /> AND EMPLOYERS'UAe1UTY Y IN
<br /> ANY PROPRIETDRIPARTNERIE,XECUTNE. NIA
<br /> (MandAW�ry In RN) 1 4910523A IOU, WA) EL EACH ACCIDENT $ ,,.1,,000,000
<br /> OFFICERRAEn EXCLUDED F49105199 (CA, NA) E L DISEASE.-EA EMPLOYEES 1,009,000
<br /> NN)
<br /> I_Hy�A aa5cibe,dar 'O49105228 ITNI
<br /> lesli t8 OF Ones 14N9Webs. ,....... L DISEASE.P(AyCYLIMIT-S 1 DDO 0$
<br /> If
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(AIWA ACORO 101,Addl1anal Remarha Schedule,Emote space Is required)
<br /> Certificate is issued as evidence of insurance per the policy terms, conditiona, and exclueiona,
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY DF THE ABOVE DESCRIBED POLICIES BE.CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> For Information Purposes Only
<br /> AUTHORIZED REPRESENTATIVE
<br /> ICrista Dean/KHD `(.
<br /> ACORD 2'5(2009109) Il 1908-2009 ACORD CORPORATION. Al)nights reserved.
<br /> INS025I26onca1 The ACORD name and logo are registered marks of ACORD
<br />
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