2018-288-E DSS - KAH Care right at Home

Browse Search

DocuSign Envelope ID: D04FOC3D- 1C804EK- AF06- 1741EB6CCB39 KAHCA -1 QP ID: KJ DATE (MMIDOIYYYY) �� CERTIFICATE OF LIABILITY INSURANCE 1�-� 0611312018 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 poiicy(ies) 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 828- 396 -3342 24-1A Tony McCroskey, CIC Granite Insurance Agency, Inc. PHONE 828- 396 - 3342 F 828 - 396 -3834 56 North Main Street AIc No, Ext : Arc, No Past Office Drawer 620 A6 AIL tmccroskey@graniteinsurance.com Granite Falls, NC 28630.0620 Tony MCCroskey, CIC INSURER(S) AFFORDING COVERAGE NAIC 4 INSURER A : Synergy Insur nce_Company 12773 INSURED KAH care, LLG DBA Right at Home 4905 Pine Cane Drive, Suite 2 Durham, NC 27707 INSURER e:StarNet Insurance Company INSURER C: _- INSURER D: INSURER E: INSURER F: nrarrrrrwrc ■ii RAnco. CG>_lIQInM MI lmprR• 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, AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _EXCLUSIONS INSR TYPE OF INSURANCE TR DDL:SUBR POLICY NUMBER POLICY EFF POLICY EX? LIMITS B B X COMMERCIAL GENER.AI LIABILITY CLAIMS -NIADE OCCUR X Professional Liab HHS 8687880-11 HHS 8687880 -11 0211612018 0211612018 02/1612019 02/1612019 EACH OCCURRENCE DAMAGE TO RENTED $ 1'000'000_ 1 00 000 'QOQ MED EXP An ons erson IM EA/3M AGG PERSONAL & ADV INJURY 1,0{}0'000 3,000,000 3,000,000 , -.._.- GEN'L AGGREGATE LIMIT APPLIES PER: I PRo POLICY � JECT LOC I OTHER: GENERAL AGGREGATE Pr200UOT5- COhtPlOPAGG B AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED ]( NON -OWNED AUTOS ONLY AUTOS ONLY - iHHS 8687880 -11 s 0211812018 02116/2019 ` I COMBINED SINGLE LIMIT 1,00(l,000 $ _ eo[my wuRY Per terson *� BODILY INJURY jeer accident $ �err?aCr�de {[}AMAGE } i UMBRELLA LIAR I EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE AGGREGATE ❑Eq RETENTION $ A WORMERS COMPENSATION ANDEMPLOYERS' LIABILITY YIN rp�� ANY PROPRIETORIPARTNEWEXECUTIVE L 1 OFFICERW MBER EXCLUDER? (Mandatory r} NH) II yes, describe under DESCRIPTION OF OPERATIONS below i N I A J WC100- 000481.118 0510512018 I 05/0512019 PER T OTH- - 1,000,000 E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYE -. ___.... _.�_1' 000, 000 1 �QQQ�QQQ E.L.. DISEASE - POLICY LIMIT B B Crime)Empioyee The Abuse /Molestation HHS 8687880 -11 HHS 8687+880.11 0211612018 02/1612018 0211612019;C rime/Em p 02/1612019 `1,000,000 50,000 3,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) ORANG -1 Orange County Department of Spacial Services PO Box 8181 Hillsborough, NC 27278 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE �A_ ACORD 25 (2016103) @ 1988 -2015 ACORL7 CORPORATIONS. All rights reserved. The ACORD name and logo are registered marks of ACORD