2017-472-E DSS - Happy Homecare Staffing, Inc. for RN services

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, •-- t GATE(MMJD Dr(rrig DocuSign�lope ID:4ED1919B-8BFA-4385-BOCC-6310D35F6154 LIABILITY INSURANCE 6/9/2017 ° THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERT•I�F�IICC1iATE HOLDER, THIS 1 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 RET1VEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: tr the certificate holder is an ADDITIONAL INSURED,the polloy(fes)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 thls certificate dons not confer rights to the certificate holder In lieu of such endorsement(s). .. - P, PRODUCER CONfACT Martha Dickerson I NAME: _____ -- Lester Ins. Group, Inc, T/A The Harper Agency �P-mg"o.Eall� (336)227-4271 FAG�N tx�6fxzz-9a57 1037 S, Hain St. dAILi9:mart:ha.dickerson@harperinsurancn.00m - INS UREEtS)AFFORDING COYERAGE RAIL a Burlington HC 27215 — INSURER s,>?roAaauranco Spocia1ty_Insurance INSIIREO INSURER B: nappy Honecare Staffing Inc. INS mu c 6720 Pentecost Rd. INSURER a INSURERS: CedRr Grove NC 27231 INSURER E' COVERAGES CERTIFICATE NUMBER;CL1731407766 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 ti 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 PAN)CLAIMS- IrTSR' ....—•AI}OL'SU5R{{ POLICY Ur POLICY D ------ -_. LTR TYPE OF INSURANCE INSD WYLLI POLICY NUMBER IMM10DIYYYYI IHMIDWY7YY1„ LAMS X COMMERCIAL GENERAL LIAIWILITY EACH OCCURRENCE $ 1,000,000 A i cIItIA1s•IJV+DE I,X I OCCUR 004,'�GE TO Fi1:NTE0- 503 000 9RF_MIg (rn oorl gna l 5 — - _. 10osrct13},52D1) 3/15/201.1 3(15/2010 MOEXP!Anyow)person}._ s_-- RA 5,000 --•T PERSONAL&AM/INJURY $ 1,000,000 GEW.AGGREt¢ATC MIT APPLIES PETE OFNERALAGGRECATE S 2,000,000 X POLICY Ni�Jgc 100 PRODUCTS•t'.Oh1P}(3P AGO 5 2,000,000 :OTHER PlWessknol Llal ny 3 1,000,000 I� AUTOMOBILEUABIUTY v COMaINED SINGLE LIMIT (Ea v;Gdantl $ _ ANY AUTO BODILY INJURY(Pte P:11'c ) 5 •.— AUTOS�Ep AUTQSULEO MEALY INJURY O'er occident) $ NON-ORA EO PROPERTY DAAAAr3s $ HIRER AUTOS S — AUTOS _LPg(_�;�c•�3pnt} ail $- UMBRELLA DAB OCCUR EACH OCCURRENCE S EXCESS LIAO CLAIMS_l1 OE, AGGREGATE $ 0EO 1 RtTENTION$ 5 j WORKERS COMPENSATION PER 10TIH- SI AND EMPLOYERS'LIABILITY Y t N -..__I_ T 4]i;._. 1.ER ANY --- ANY PROPRIETORI ARTNERIEXECUTIVE n N r A ESL EACH ACCIDENT S —_- OrF10ERIRIE[dSER E;tCLU0EU9 (Mandatary In NH) EL-DISEASE-EA EMPLOYE 1,_ — —.- --.-Units=aO7OPEIOI0NS leow 17,1_DISEASE-POLICY LMIT S »............._....._ DESCRIPTION OF OPERATIONS I LOCATIONS i VEHICLES (ACORC 1111,AdSIIIOnet Hamelin Schndula,mxy MI apache.if morn apace Ira ruqulroa) Includes Sensual Mo1ostation $250,000 per Incident and $750,000 Annual Aggregate. CERTIFICATE HOLDER CANCELLATION jJ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County Social Services THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 7? 0 Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS. • • • tii.lisboz.ougla, NC 27270 • AUTHORIZED REPRESENTATIVE 1s Martha Dickerson/MHO f Ick e•-*/-,ei-, -1.-3 r c.��.,,/^r.a,y-,. I ©1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are regIstered marks of ACORD INS02512€11401) 1 ;