2018-006-E DSS - CNC Access In Home Aide Provider Services Agreement

Browse Search

DocuSign Envelope ID: 1CB2CA10- 4240 -4l A2- A2C5- FBC446A9EE9B ACUR"' CERTIFICATE OF LIABILITY INSURANCE `� 7n/2018 DATE(MMIDDIYYYY) F 6/21/2017 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(les) must have ADDITIONAL INSURED provisions or 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 LOCKTON COMPANIES 2100 ROSS AVENUE, SUITE 1400 DALLAS TX 75201 214 - 969 -6700 NAME: IONE FAX AEC No, Exf : (A/C, No): E -MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC N INSURERA: ACE American Insurance Company 22667 INSURED Res -Care, Inc. and all scheduled subsidiaries 1068789 9901 Linn Station Road Louisville KY 40223 NSURER B : Endurance American Insurance Company 10641 INSURER C: See Attached 7/1/2018 INSURER D: 4,000,000 INSURER E: DAMAGE TO RENTED PREMISES Ea occurrence INSURER F : • COVERAGES *RESCA01P* CERTIFICATE NUMBER: 10908335 REVISION NUMBER: Y=XXXX 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. INSR LTR TYPE OF INSURANCE ADDL INSR Sl1BR wvp POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYYY LIMITS A A X COMMERCIAL GENERAL LIABILITY X CLAIMS -MADE ❑ OCCUR Prof. Liability N N XSL 627867881 (CLAIMS MADE) 7/1/2017 7/1/2018 EACH OCCURRENCE 4,000,000 DAMAGE TO RENTED PREMISES Ea occurrence 3OO OOO • MED EXP (Any one person) XXXY= • SeXAbuse /Molestation PERSONAL & ADV INJURY $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: }` POLICY❑ JE� F LOC OTHER: GENERAL AGGREGATE $ 6,000,000 PRODUCTS - COMPIOP AGG $ 4,000,000 $ A AUTOMOBILE LIABILITY OWNED SCHEDULED Ix ANY AUTO AUTOS ONLY AUTOS ALTOS ONLY X AUUTO ONLY N N 1SA 1- 10905991A 7/1/2017 7/1/2018 EO IIIN EI),SINGLE LIMIT s2,000,000 BODILY INJURY (Per person) $ XX}�}�XXX BODILY INJURY (Per accident $ XXXXXXX PPe�acclden ©AMAGF $ XXXXXXX $XXXXXXX B B UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE N N 1 XSC30000119101 (AUTO & EL ONLY) 1 7/1/2017 7/1/2018 EACH OCCURRENCE $ 3,000,000 AGGREGATE $ XXXXXXX DIED I I RETENTION $ $ XXXXXXX C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOWPARTNERIEXECUTIVE OFFICERWEMBER EXCLUDED? (Mandatary in NH) describe under DESCRIPTION PT ON OF OPERATIONS below NIA N SEE Al "1ACI -1GD PER OTH- X STATUTE I ER E.L. EACH ACCIDENT $ 2,000,000 E.L. DISEASE - E.A EMPLOYEE 2,000,000 E.L. DISEASE- POLICY LIMIT n 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 161, Additional Remarks Schedule, may be attached if more space is required) Retro Date for Policy #XSL 627867881 is 7 /1 /01. Coverage does not exclude Sexual Abuse / Molestation. CERTIFICATE HOLDER CANCELLATION See Attachment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION BATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10908385 AUTHORIZED REPRESENTATIVE Orange County DSS 2501 Homestead Road Chapel Hill NC 27516 ACORD 25 (2016103) ©1988 -2015 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD