2018-363-E Health - Brian Swift dental services

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DocuSign Envelope ID: 5280ClBl- 5lA7 -4D85- BDBA- 2A9524E399BB 9-F"" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 10/06/2017 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(ies) must 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 APP /B & B Protector Plans, Inc P.O. Box 172057 Tampa, FL 33672 CONTACT NAME: Renee Pfefferle PHONE FAX A/C No E -MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURERA : Continental CasualtV Company LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE D OCCUR , INSURED INSURER B : INSURERC: EACH OCCURRENCE Brian James Swift, DDS INSURER D : DAMAGE PREMISES Ea occurrence 4010 Sweeten Creed Rd. INSURERE: MED EXP (Any one person) Chapel Hill, NC 27514 INSURER F : PERSONAL &ADV INJURY $ KCvIAIVIV IVUMtlt K: 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 9W LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF IMMIDDffYYYI POLICY EXP (MMIDDIYYYY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE D OCCUR , r I EACH OCCURRENCE $ DAMAGE PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL &ADV INJURY $ GENERALAGGREGATE $ GEN'L AGGREGATE U MIT APPLIES PER: POLICY PRO LOC PRODUCTS - COMP /OPAGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS �._ �I COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAB EXCESS LIAB HOCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N OFFICEIMEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA WC STATU - OTH- - ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT 1 $ A Professional Liability: Occurrence Policy t —; I (` 3 - 428299727 09/18/2017 09/18/2018 $1,000,000.00 per claim/ $3,000,000.00 aggregate DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace Is required) \.CR 1 1r 1\.A 1 C r1VLUtK CANCELLATION Brian James Swift 4010 Sweeten Creed Rd. Chapel Hill, INC 27514 ACORD 25 (2010/05) 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 ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD