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DocuSign Envelope ID:B 156146B-0400-4433-84BD-A56E1 DCE5DA7 <br /> -1 ® DATE(MM/DD/YYYY) <br /> �` CERTIFICATE OF LIABILITY INSURANCE 08/31/2017 <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 have ADDITIONAL INSURED provisions or be endorsed.If m <br /> SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this w. <br /> certificate does not confer rights to the certificate holder in lieu of such endorsement(s). c <br /> PRODUCER CONTACT — <br /> NAME: <br /> Aon Risk Services Central, Inc. PHONE (866) 283-7122 FAX (800) 363-0105 v <br /> southfi el d MI office <br /> (NC.No.Ext): (NC.No.): .a <br /> 3000 Town Center E-MAIL <br /> Suite 3000 ADDRESS: S <br /> Southfield MI 48075 USA <br /> INSURER(S)AFFORDING COVERAGE NAIC 8 <br /> INSURED INSURER A: Zurich American Ins Co 16535 <br /> Delta Dental of North Carolina INSURER B: The Continental Insurance Company 35289 <br /> 4242 Six 27609 USA x Forks Road, Suite 970 <br /> Raleigh INSURER C: Allied World Surplus Lines Insurance Co 24319 <br /> INSURER D: , <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 570068227301 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. Limits shown are as requested <br /> INSR ADDL SUBR POLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDDIYYYY) IfMMIDDIYYYY LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY CPO948721606 06/15/2017 06/15/2018 EACH OCCURRENCE $1,000,000 <br /> CLAIMS-MADE X OCCUR DAMAGE TO RENTED $1,000,000 <br /> PREMISES(Ea occurrence) <br /> MED EXP(Any one person) $10,006 <br /> PERSONAL&ADV INJURY $1,000,000 0 <br /> GE AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 r <br /> X POLICY PRO- I LOC PRODUCTS-COMP/OP AGG $2,000,000 co <br /> OTHER: o <br /> N- <br /> A AUTOMOBILE LIABILITY BAP 9487215-06 06/15/2017 06/15/2018 COMBINED SINGLE LIMIT $1,000,000 <br /> (Ea accident) .. <br /> X ANY AUTO BODILY INJURY(Per person) 0 <br /> - OWNED —SCHEDULED BODILY INJURY(Per accident) 'Ol <br /> AUTOS ONLY AUTOS +' <br /> HIRED AUTOS NON-OWNED PROPERTY DAMAGE U <br /> ONLY —AUTOS ONLY (Per accident) y:. j- <br /> no <br /> B X UMBRELLA LIAB X OCCUR 6049723206 06/15/2017 06/15/2018 EACH OCCURRENCE $10,000,000 0 i? <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 <br /> DED I RETENTION <br /> A WORKERS COMPENSATION AND WC948721706 06/15/2017 06/15/2018 I PER oTH- <br /> EMPLOYERS'LIABILITY Y/N X STATUTE ER <br /> ANY PROPRIETOR/PARTNER I EXECUTIVE E.L.EACH ACCIDENT $1,000,000 <br /> OFFICER/MEMBER EXCLUDED? N N I A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 <br /> E yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000— <br /> c ManageCare Liab 03047047 06/15/2017 06/15/2018 Per Claim Limit $1,000,000— <br /> E&O-Claims-Made Policy Aggregate $1,000,000 i <br /> SIR applies per policy terns & condi'ions <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Retro Date: 09/23/1957. 311... <br /> i.e <br /> n <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br /> EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE <br /> POLICY PROVISIONS. r <br /> 1-2 <br /> Brenda Bartholomew AUTHORIZED REPRESENTATIVE <br /> Orange County Human Resources Department Ems'. <br /> 200 south Cameron street <br /> Hillsborough NC 27278 USA ` ..a,c s p i . - <br /> n�4 cJ - <br /> ©1988-2015 ACORD CORPORATION.All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br /> 1 <br />