2018-475-E Finance - Piedmont Health Services Inc outside agency agreement

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DocuSign Envelope ID: CCFF6125- AA47- 438A- 98CA- B42519499D42 CERTIFICATE OF LIABILITY INSURANCE 7DAT7E1,IyIM1DD[YYYY) 89/2018 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 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 Marsh & McLennan Agency LLC 440 South Church St., Ste 500 Charlotte NC 28202 CONTACT NAME: Kendra A. Biddle, CPCU, CIC PHONE FAX AIC No Ext : 336- 899 -2410 AIC No): 212- 607 -6554 ADDRESS: Kendra.Biddle@marshmma.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: AIX Specialty Insurance Company 13763 10/11/2017 INSURED PIEDMHEAL9 Piedmont Health Services Inc. 127 Kingston Drive INSURER 13: StarNet Insurance Company 40045 INSURER C: AllmeriCa Finanical Benefit Insurance 41840 INSURER D: Chapel Hill NC 27516 INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: 116533626 REVISION NUMBER: 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 INSD SUBR WVD POLICYNUMBER POLICY EFF MM /DDIYYYY POLICY EXP MM /DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY L16A73441101 10/11/2017 10/11/2018 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS -MADE X OCCUR PREMISES Ea occurrence $ 100,000 X MED EXP (Any one person) $ 5,000 1,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY ❑ PRO- ❑ LOC JECT PRODUCTS - COMP /OP AGG $ 3,000,000 $ OTHER: C AUTOMOBILE LIABILITY AW6A534528 10/11/2017 10/11/2018 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY A UMBRELLA LIAB OCCUR L16A73441201 10/11/2017 10/11/2018 EACH OCCURRENCE $ 5,000,000 X AGGREGATE $ 5,000,000 EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN KEY0136292 2/1/2018 2/1/2019 X PER 0TH- STATUTE ER ANYPROPRIETOR /PARTNER /EXECUTIVE E.L. EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 A Professional L16A73441101 10/11/2017 10/11/2018 Incident 1,000,000 Liability Aggregate 3,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION ©1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Orange County Government ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Human Services 200 S Cameron Street AUTHORIZED REPRESENTATIVE P O Box 8181 Hillsborough NC 27278 ©1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD