2017-533-E DSS - Senior Care of Orange County for Adult Day Health

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DocuSign Envelope ID: FBF0391 D-70C4-4BC1-A063-A23742F80EC1 Client#: 955852 04SENIOCARI MMlD{IfYYYY} ACORDTH CERTIFICATE OF LIABILITY INSURANCE o7E DATE(MM!DO! 7 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 NAME: BB&T Insurance Services, Inc. (arcG, o,Ext):888 743-2217 FAX No); 8888279861 414 Galllmore Dairy Road E-MAIL ADDRESS: Suite F INSURER(S)AFFORDING COVERAGE NAIC Greensboro, NC 27409 INSURER A;Evanston Insurance Company 35378 INSURED INSURER B;Markel Insurance Company 38970 Senior Care of Orange County Inc INSURER C: Attn Day Health Center - INSURER D: 105 Meadowlands Dr Hillsborough,NC 27278-8181 INSURER/: 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. LTR TYPE OF INSURANCE INSR wvD r POLICY NUMBER ` POLICY EFF POLICY EXP LIMITS ;MMlDDlYYYY) (MMfaD1YYYY) A X COMMERCIAL GENERAL LIABILITY X SM921051 07/13/2017 07/13/2018 EEACHqA�GOCCCpoURRENCE $1,000,000 X CLAIMS-MADE OCCUR PRlMISES(EaEo cuErrDence) $50,000 X BI/PD Ded:5,000 MED EXP(Any one person) $5,000 PERSONAL&ADVINJURY $1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 PRO- POLICY JECT LOC PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident} yQ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED LRETENTION$ $ B WORKERS COMPENSATION MWC010610201 02/08/2017 02/08/2018 X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y1 N ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? y N I A (Mandatory in NH) E,L,DISEASE-EA EMPLOYEE $500,000 if yes,describe under DESCRIPTION OF OPERATIONS below E.L.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/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached It 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-Pol.#SM921051 (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION Orange County Government SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 S Cameron Street ACCORDANCE WITH THE POLICY PROVISIONS. Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE S.L4k, kVIU,Wc ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) 1 of 2 The ACORD name and logo are registered marks of ACORD #S185106961M18508092 JUSC