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DocuSign Envelope ID:84924C7D-EDF6-41 D3-81 F5-3503EDF23805
<br /> ___...---.IN FLAIINC-01 MROBERTS
<br /> ACOREY DATE(MMlDLI YYYY)
<br /> •
<br /> `� CERTIFICATE OF LIABILITY INSURANCE as�zsr2o17
<br /> THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS i
<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 have ADDITIONAL INSURED provisions or be endorsed.
<br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on
<br /> this certificate does not confer rights to the certificate holder In lieu of such endorsement(s).
<br /> PRODUCER NAAMEACT
<br /> Summers Thompson Lowry,Inc. PHONE 919 9684472 FAx )
<br /> 700 Europa Drive
<br /> {A/C,No,Ext1:( ) (NC,Noh(919 942-4221
<br /> Suite 571
<br /> E-MAIL
<br /> ADDRESS:.info@STLinsure.com
<br /> Chapel Hill,NC 27517-2393 INSURERS)AFFORDING COVERAGE NAIC E
<br /> INSURER A:ACE USA(Inland Marine)
<br /> INSURED INSURER e:Allmerica Financial Benefit
<br /> Flaircare,Inc DBA INSURER c:Accident Fund National Ins Co. 12305
<br /> Homewatch Caregivers of the Triangle ,
<br /> 1210 SE Maynard Rd.Suite 202 INSURER D:
<br /> Cary,NC 27511 INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 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 ADOL SUER POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER IMMIDDIYYYYI IMMIDDIYYYYI LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> X CLAIMS-MADE OCCUR MLP G27939594 001 0110112017 01/01/2018 DAMGEO ENuED ncej $ 100,000
<br /> MED EXP(Any one person) $ 10,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE ITAPPLIESPER; GENERAL AGGREGATE $ 3,000,000
<br /> LiM
<br /> POLICY 128i LOC PRODUCTS-COMP/OP AGG $ 1,000,000
<br /> OTHER: $
<br /> B AUTOMOBILE LIABILITY
<br /> COMBINED tlEEDISINGLE LIMIT $ 1,000,000
<br /> ANY AUTO AW6D229198 04/18/2017 04/18/2018 BODILY INJURY(Per person) S
<br /> OWNED AUTOS ONLY X SCHEDULED BODILY INJURY(Per accident) S
<br /> AUTOS ONLY AUTOS ONLY fPerraco((uentjAMAGE S
<br /> S
<br /> UMBRELLA L1AB _ OCCUR EACH OCCURRENCE $
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $
<br /> DED RETENTIONS $
<br /> C AND EMPLOYERS LIABILITY PER EERH
<br /> YIN WCV801303900 • 01101/2017 01/01/2018 500,000
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
<br /> {OAFFIC Rory In BE EXCLUDED? Y NIA
<br /> E.L.DiSEASE-EA EMPLOYEE$ 500'400
<br /> if yes,describe under 500,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> A Abuse/Sex Molestatio MLP G27939594 001 01/01/2017 01/01/2018 Limit 1,000,000
<br /> A Professional Liab MLP G27939594 001 01/0112017 01/0112018 Limit 3,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
<br /> Proprietors,Partners,Executive Officers,Members Excluded as follows:
<br /> AnzorGachechiladze,President;Stephanie Wrights,Vice President;Kimberly A.Gachechiladze,Secretary/Treasurer
<br /> For Information Purposes
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1
<br /> Orange County Department on Aging THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN I
<br /> g Y p g g ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 600 NC-86
<br /> Hillsborough,NC 27278
<br /> •
<br /> •
<br /> AUTHORIZED REPRESENTATIVE
<br /> d�on1 PI sv„„mA.5
<br /> I I
<br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
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