2017-413-E Aging - Senior Care of Orange County Inc. for adult day health care services

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DocuSign Envelope ID:30CFBA21-DC65-423A-A674-7D24A692C6ED Ciient#:955852 04SENIOCARI ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD1YYTT) 07/20/2017 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 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 BB&T Insurance Services,Inc. PHONE Fax [Arc,No,ext):888 743-2217 (Arc,No): 8888279861 414 Gallimore Dairy Road E-MAIL Suite F ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC Greensboro, NC 27409 INSURERA:Evanston Insurance Company 35378 INSURED INSURERS,Markel Insurance Company 38970 Senior Care of Orange County Inc INSURER C: Attn Day Health Center 105 Meadowlands Dr INSURER Hillsborough, NC 27278-8181 INSURERS: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 N RL WVD POLICY NUMBER (MMIDDIYYYY) (MMMDPIYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY X SM921051 07/13/2017 07/13/2018 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED X CLAIMS-MADE OCCUR PRE ISE a occurrence) $50,000 X BI/PD Ded:5,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 PRO. POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY AUTOS AUTOS Per accident)} $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE _ AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION MWC010610201 02/08/2017 02/08/2018 X PER OTH- AND EMPLOYERS'LIABILITY Y f N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE' E.L-EACH ACCIDENT $500,000 OFFICERIMEMBER EXCLUDED? Y� N 7 A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below El,DISEASE-POLICY LIMIT $500,000 A Professional SM921051 07/13/2017 07/13/2018 $1,000,000 each claim Liability $3,000,000 aggregate $5,000 deductible DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Policy includes endorsement that provides Additional Insured status for any Landlord,Owner,or Property Manager of the Designated Premises or any Tradeshow or Convention Sponsor or operator or any lessor of equipment. Professional Liability-Poi.#SM921051 (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION Orange County Government SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 S Cameron Street ACCORDANCE WITH THE POLICY PROVISIONS. Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE ktUntall ©1988 2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) 1 of 2 The ACORD name and logo are registered marks of ACORD #818510696/M18508092 JUSC