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DocuSign Envelope ID: 535BB656- 53CF- 457A- 98B2- D73B9641501 D <br />Client#: 955852 <br />04SENIOCARI <br />AC ®R ®T,. CERTIFICATE OF LIABILITY INSURANCE <br />r ATE(MMJD13NYYY) <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />07/20/2017 <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 INSURERS), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(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 <br />CONTACT <br />NAME: <br />i3B &T Insurance Services, Inc. <br />PuHCG Ne Eld :888 743 -2217 No; 8888279861 <br />414 Gallimore Dairy Road <br />E -MAIL <br />Suite F <br />ADDRESS: <br />07/13/201 <br />Greensboro, NC 27409 <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />INSURER A: Evanston Insurance Company <br />35378 <br />MEDFXP (Any one person) <br />INSURED <br />INSURER B: Markel Insurance Company <br />38970 <br />Senior Care of Orange County Inc <br />Attn Day Health Center <br />INSURER c <br />PERSONAL $ AOV INJURY <br />105 Meadowlands Dr <br />INSURER D <br />Hillsborough, NC 27278 -8181 <br />INSURER E: <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRO - <br />POLICY JECT El LOG <br />GENERAL AGGREGATE <br />$3,000,000 <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 CONTRACTOR 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 />LTR <br />TYPE OF INSURANCE <br />tNgDL <br />SU D <br />POLICY NUMBER <br />POLICY 0fYYY <br />POLICY flNYYY <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />X CLAIMS•MAOE OCCUR <br />X <br />SM921051 <br />7/13/2017 <br />07/13/201 <br />$1,0,(0,0 00 <br />❑EAACyHpOCCURRENCE <br />PREMISES EaoNccTu ante <br />$50000 <br />X <br />MEDFXP (Any one person) <br />$5,000 <br />1311PD Ded:5,000 <br />PERSONAL $ AOV INJURY <br />$1,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRO - <br />POLICY JECT El LOG <br />GENERAL AGGREGATE <br />$3,000,000 <br />PRODUCTS • COMP /OP AGG <br />$ <br />$ <br />OTHER: <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />1 <br />BODILY INJURY Per accident <br />( ) <br />$ <br />NON -OWNED <br />HIRED AUTOS AUTOS <br />k <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />$ <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAR <br />DEO RETENTION $ <br />$ <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETORIPARTNERIEXECUTIVE <br />OFFICERIMEMBER EXCLUDED? <br />N 1 A <br />MWC010610201 <br />2/0812017 <br />02/0812018 <br />X 1psTEARTLITE I IOTH- <br />E.L. EACH ACCIDENT <br />$500,000 <br />E.L. DISEASE - EA EMPLOYEE <br />$500 000 <br />(Mandatory In NH) <br />If Dyes, IPTIONunder <br />DESCRIPTION OF OPERAT €DNS Below <br />E.L. DISEASE - POL €CYLIMIT <br />$500,000 <br />A <br />Professional <br />SM921051 <br />7113/2017 <br />0711312018 <br />$1,000,000 each claim <br />Liability <br />$3,000,000 aggregate <br />$5,000 deductible <br />DESCRIPT€ON OF OPERATIONS 1 LOCATIONS f VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) <br />Policy includes endorsement that provides Additional Insured status for any Landlord, Owner, or Property <br />Manager of the Designated Premises or any Tradeshow or Convention Sponsor or operator or any lessor of <br />equipment. <br />Professional Liability - Pol.# SM921051 <br />(See Attached Descriptions) <br />Orange County Government <br />200 S Cameron Street <br />Hillsborough, NC 27278 <br />ACORD 25 (2014101) 1 of 2 <br />#S18510696IM18508092 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />Uk' <br />O 1988 -2014 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />JUSC <br />