2018-493-E Health - El Futuro mental health services

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AFEnvelope ID: C3C9F04F- 5F60- 45DB- 9D9D- ABDCD1AD4F94 VSK CERTIFICATE OF LIABILITY INSURANCE 8045 DATE(MM /DD/YYYY) F8/20/2018 THIS CERTIFICATEIS 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 PAYCHEX INSURANCE AGENCY INC /PAC 250881 P: F: (888) 443 -6112 PO BOX 33015 SAN ANTONIO TX 78265 CONTACT NAME: (A/oN,Ext): (,C,No): (888) 443 -6112 E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Trumbull Ins Co 27120 INSURED EL FUTURO 136 E CHAPEL HILL ST DURHAM NC 27701 INSURER B COMMERCIAL GENERAL LIABILITY INSURER C: INSURER D: INSURER E: EACH OCCURRENCE INSURER F: COVERAGES CERTIFICATE NUMBER: 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. IASR LTR TYPE OF INSURA NCE ADDL IN SR SUBR WVD POLICYNUMBER POLICY EFF (MM/DD/YYYY) POLICYEXP MMDD YYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE ❑ OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ GEN'L POLICY PRO LOC JECT PRODUCTS - COMP /OP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 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 $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DE D RETENTION $ $ WORRE'RSCOMPEN.SATION AN'DEMPLOYERS'LLABILITy PER OTH- X STATUTE ER E.L. EACH ACCIDENT $1, 0 0 0 , 000 ANY PROPRIETOR /PARTNER /EXECUTIVE Y/N A OFFICER /MEMBER EXCLUDED? (Mandatory in NH) F NIA 76 WBG ZS2911 11/12/2017 11/12/2018 E.L. DISEASE -EA EMPLOYEE $1, 000, 000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1 0 0 0 000 I I DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. CERTIFICATE HOLDER CANCELLATION Orange Attn : County Finance Dept 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 CJ� �GLD 200 S. Cameron St PO 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