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DocuSign Envelope ID:4ED1919B-8BFA-4385-BOCC-6310D35F6154 • <br /> A_ .DT. CERTIFICATE OF LIABILITY INSURANCE <br /> Aprilg4�2017 <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 en ADDITIONAL INSURED,the pn€icy(€es)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and <br /> conditions of the policy,certain po€Ides may requite an endorsement.A statement on(his certificate does not confer rights to the certificate holder in lieu of <br /> such endorsernent(s}. <br /> PRODUCER CDITACT <br /> The Solutions Group NAME: David Dickie <br /> � P€ICN€= FAX <br /> 2211 N.W. Military Hwy,, Ste 211 we,No,E.ne:(230)490-7200 J(AIC,N01:(813I:).) 847-7232 <br /> San Antonio, TX 78213 --- <br /> ADDRESS: <br /> — — — INSURERS AFFORDING COVERAGE <br /> INSURED INSURER A:A_shmere Insurance Company <br /> Happy HorneCare Staffing, Inc. <br /> 6720 Pentecost Rd. INSURER C. <br /> Cedar Grove, NC 27231 INSURER D. <br /> INSURER D. <br /> INSURER P2 <br /> COVERAGES <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW l LAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY <br /> PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT W I f Ii RESPECT 10 <br /> WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT 10 <br /> ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCI I POLICIES,L,MITS SHOWN MAY,H,AVEBEEN IE REDUCED ED t3YPAi€ CI AIMS <br /> INSR' I D ..__Cwvrf 51WOOrYE POLICY <br /> MM 1=%y -_.... ---'--------•---' ---._'- <br /> L1Ti _ TYPE OP INSURANCE €'OLICY NUMHFR OAJ"E�(MM117rT11`Y} DATE((M3ulfnr]]YY �----rlMmb.....,.._._,..,..,.._.,.._.,_...,.._._.._......_... <br /> GENFRAI LIABILITY EACEI OCCURRENCE <br /> COMMERCIAL,GENERAL IIASILItY FIRE DAMAGE(Any me fire <br /> CLAIMS MADE OCCUR MOD EXP(Any orra penerm( <br /> PERSONAL A ADV INJURY <br /> s <br /> 3 <br /> GENERAL AGGREGATE <br /> OWL AS",G€?FOAL€E I.IMITAPPLIES PER: PRODUCTS--COMP/OP AGE <br /> POLICY f PRO- LOG .. <br /> JECT <br /> AUTOMOBILE LIABILITY <br /> COMBINED SINGLE LIMIT <br /> ANY AUTO (Ea arxidenl) �" 6 <br /> ALL OWNED AUTOS <br /> MAY INJURY �-rv,_._...___......._,__..__...__...�.._.__ <br /> SCHEDULED AUTOS I tf'er peJaaii) <br /> r HIRED AU ID;; I 11701!-Y INJURY <br /> NON-OWNED AUTOS (Peraceidunt) <br /> EXCEBS LIABILITY <br /> 'EACH OCCURRENCE $ I <br /> OCCUR CLAIMS MADE 'AGGREGATE S <br /> t)LDIJL I IRLE: <br /> RETENTION 5 I � <br /> woRrtEtzscofnPENSanoNANn WCP404043041A1C 43l2612417 03126!241$ X I T(743511vt€4„1 art _.. <br /> EMPLOYERS'LIABILITY <br /> FA_EA ACCIDENT 5700000 <br /> El,DISEASE-EA EMPLOYEE T 1OfI,000 - <br /> _ I <br /> C .s500,000 El.DISEASE-POLICY Ll:-ell <br /> OTNE_R I I <br /> i I <br /> DESCRIPTION OF OPERATIONf1.00AT1ONSIVEHICLES(EXCLUSIONS ADDED fly EUUGHSEMFNT/SPECIAL.PROVISIONS <br /> Company Contact: Lesa Kendrick <br /> CERTIFICATE HOLDER ADDITIONAL INSURED:INSURER LL+r IL-N: CANCELLATION ' <br /> Proof Of Insurance SHOULD ANY or THE ABOVE DESCRIBED POLICIES BE CANCELLED BE- <br /> FORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <br /> • <br /> I <br /> • <br />