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DocuSign Envelope ID: 1AA2F077-28D9-471D-964E-FC29B8D9OBCA
<br /> i� 1 ® RATE(MMIDDIYYYYJ
<br /> ACORO CERTIFICATE OF LIABILITY INSURANCE
<br /> 411.------ 6/30/2017
<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 an ADDITIONAL INSURED,the policy(ies)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 on this certificate does not confer rights to the
<br /> certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT
<br /> NAME: Margie Lagazon
<br /> Miller&Miller Insurance Agency Inc {t{qAII1CD.NN.Extl:914-741-6400 iwc,Ne1:914-741 6407
<br /> 720 Commerce Street e.mitiL
<br /> Thornwood NY 10594 ADDRESS:MargieL( Miller-Ins.com
<br /> INSURER{S)AFFORDING COVERAGE NAIC#
<br /> INSURER A:ACE AMERICAN INSURANCE COMPANY 22667
<br /> INSURED PREMI-4 INSURER B:NATIONAL CONTINENTAL INS CO 10243 d
<br /> Premier Home Health Care Services Inc INSURERC:COVERYS SPECIALTY INSURANCE COMPANI5686
<br /> 445 Hamilton Avenue, 10th Fl INSURER 0:CHARTER OAK FIRE INS CO 25615
<br /> White Plains NY 10601
<br /> INSURER E:TRAVELERS IND CO 25658
<br /> INSURER F:)-IISCOX INS CO INC 10200
<br /> COVERAGES CERTIFICATE NUMBER:1424521727 REVISION NUMBER:
<br /> THIS IS TO CERTIFY THAT THE POLICIES 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 /> INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
<br /> LTR INSR WVD POLICY NUMBER _/MMJDDIYYYYI IMMIRD/YYYYI
<br /> A GENERAL LIABILITY MLP G28210851 001 2/2/2017 2/2/2018 EACH OCCURRENCE $1,000,000
<br /> X COMMERCIAL GENERAL LIABILITY PR S l RENTED
<br /> PREEMIMI E SES(Ea occurrence) $50,000
<br /> CLAIMS-MADE X OCCUR MED EXP(Any one person) $5,000
<br /> X PROF-CLAIMS MADE PERSONAL&ADV INJURY Si 000,000
<br /> X SEXUAL ABUSE GENERAL AGGREGATE $3,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $1,000,000
<br /> RO-POLICY J LOC Prof Aggregate Limit $3,000,000
<br /> B AUTOMOBILE LIABILITY CNY00070829937 2/212017 2/2/2018 COMBINED SINGLE LIMIT
<br /> (Ea accident) $1,000,000
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS AUTOS 1'.,
<br /> X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ,(Per accident)
<br /> $
<br /> C UMBRELLA L1A8 X OCCUR 510035 212(2017 2/2/2018 EACH OCCURRENCE $25,000,000
<br /> X EXCESS LIAB CLAIMS-MADE AGGREGATE _ $25,000,000 h
<br /> DEC X RETENTION$10,000 SEXUAL ABUSE $10,000,000 r`,
<br /> D WORKERS COMPENSATION TC2OUB1006A37217 6/30/2017 6/30/2018 X WC STATU- 0TH-
<br /> E AND EMPLOYERS'LIABILITY Y/N TRKUB3612A49617 6/30/2017 6130/2018 e h;
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000 000
<br /> OFFICER/MEMBER EXCLUDED? N N/A - — - -- -
<br /> {Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> F Employee Theft UC2118450517 2/8/2017 2/8/2018 Limit $50,000
<br /> DESCRIPTION OF OPERATIONS!LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required)
<br /> *Policies shown are subject to terms,conditions, exclusions,sublimits and deductibles not listed on this certificate. We recommend that
<br /> requests for policy copies be directed to the Named Insured shown above.*
<br /> Work Comp Policy #TC2OUB1006A37217- Covers the following States-CT, IL, NC, NJ,NY
<br /> Work Comp Policy# TRKUB3612A49617 -Covers the following States-FL, MA
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Orange County Dept of social Services THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> 113 Mayo Street ACCORDANCE WITH THE POLICY PROVISIONS,
<br /> Hillsborough NC 27278
<br /> AUTHORIZED RE ESENTATIVE
<br /> I 4.-..nl 41-12—(251—\
<br /> ©1988-2010 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD
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