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DocuSign Envelope ID:3576E911-72DE-4480-8C9C-3DE5A840178D
<br /> co CERTIFICATE OF LIABILITY INSURANCE DATE(MMiDDIYYW)
<br /> 6/26/2018
<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 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 /> Co CT
<br /> PRODUCER NAME: Margie La azon
<br /> Miller&Miller Insurance Agency Inc PHONE FAX
<br /> 720 Commerce Street ,Atc 914-741-6400 we No:914 741 8407
<br /> Thomwood NY 10594 E-MAILADDRESS: Mar IeL Miller-Ins,com
<br /> INSURERS AFFORDING COVERAGE NAIC 1'ii
<br /> INSURER A:ACE AMERICAN INSURANCE COMPANY 22667
<br /> INSURED PREMI-4 [INSURER B:National Continental Ins 10243
<br /> Premier Home Health Care Services Inc SURER C:COVERYS SPECIALTY INSURANCE COMPANY 15686
<br /> 445 Hamilton Avenue, 1Oth FI
<br /> White Plains NY 10601 SURER D:The Charter Oak Fire Ins Co 25615
<br /> SURERE:Travelers Indemnl Com an 25666
<br /> SURERF:HISCOX INS CO INC 10200
<br /> COVERAGES CERTIFICATE NUMBER:1215672678 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 /> IL POLICY EFF POLICY EXP LIMITS
<br /> TYPE OF INSURANCE POLICY NUMBER MWDD/YYW MMIDDIYYYY
<br /> A GENERAL LIABILITY MLP0282ID851002 22/2018 222019 EACH OCCURRENCE $1.D00,000
<br /> DAMAGE TU'RMITM
<br /> X COMMERCIAL GENERAL LIABILITY PREMISES Eaoccurrence) $60.000
<br /> I
<br /> CLAIMS-MADE OCCUR MEDEXP(Any one ereon $6,000
<br /> X PROF-CLAIMS MADE PERSONAL 8 ADV INJURY S 1,D00,000
<br /> X SEXUAL ABUSE GENERAL AGGREGATE $3,D0o,ow
<br /> GEHL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $1,D00 DW {
<br /> POLICY PRO-jECTLOC Prof Aggregate Limit $3,000,000
<br /> B AUTOMOBILE LIABILITY CNY0007Oa29938 2J2f2018 212/2019 COMBINED SINGLE LIMIT
<br /> Ea accident $1, 00,000 -
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS X NUTOS
<br /> O -OWNED PO ecEcRldYP4MGE $HIREDAUTOS AUTOS ar. $
<br /> $
<br /> C UMBRELLA LIAB X OCCUR 51OD36 2/22018 Mots EACH OCCURRENCE $25,000,000
<br /> X EXCESS LIAB CLAIMS-MADE AGGREGATE $25,000,000 !
<br /> DED I X I RETENTION$10 0W SEXUAL ABUSE s 10,000,000
<br /> p WORKERS COMPENSATION TC20UB1008A37218 8/302018 8/302019 X I WC S7ATU-U.T.
<br /> I JOTH-
<br /> E AND EMPLOYERS'LIABILITY YIN TRKUB3812A49618 8130f2018 B/30/2019 FR
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,D0D
<br /> OFFICERtMEMBER EXCLUDED? ❑N N/A
<br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $1,000,000
<br /> It yyes,describe under
<br /> DESCRIPTICN OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$1,0D0 000
<br /> F Employee Theft UC211845D518 2/8/2018 202019 Llmlt W 000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required)
<br /> "Polieies shown are subject to terms,conditions,exclusions,sublimits and deductibles not listed on this certificate. We recommend that requests for policy
<br /> copies be directed to the Named insured shown above."
<br /> Work Comp Policy #TC20UB1006A37217-Covers the following States-CT,IL,INC,NJ,NY
<br /> Work Comp Policy# TRKUB3612A49617 -Covers the following States-FL,MA
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<br /> CERTIFICATE HOLDER CANCELLATION
<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 /> Orange County Dept of social Services
<br /> 113 Mayo Street AUTHORIZED REPRESENTATIVE
<br /> Hillsborough NC 27278 y
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<br /> ©1988-2010 ACORD CORPORATION. All rights reserved. t
<br /> ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD
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