2018-584-E DSS - FlairCare-Homewatch Caregivers in home aide services

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DocuSign Envelope ID: D6A10EDE-9BO6-43F7-AB6A-BOCF29ADEBA4 �r FLAIINC-01 DMASO ACt?RIJI" DATE{MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 0812712018 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 INSURERS),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(les)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 Ileu of such�andorsement(s). PRODUCER I CO Summers Thompson Lowry,Inc. A No,E:1 919 968-4472 AIC,Na)T_919 942-4221 100 Europa Drive M IL Suite 571 .info @STLinsure.com Chapel HIII,NC 27517-2393 IN AFFORDING COVERAGE NAIC# INSURER A;ACE American Insurance Co 22667 INSURED INSURER a:Alimerica Financial Benefit 41844 Flaircare,Inc DBA INSURER C:Accident Fund National Ins Co. 12305 Homewatch Caregivers 1210 SE Maynard Rd.Suite 202 INSURER Q: Cary,NC 27511 INSURERE: 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. INSR 'ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE IN2512 WVO I POLICY NUMBER fly n=1 I LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000 X CLAIMS-MADE F—]OCCUR MLP 627939594 003 0110112018 0110112D19 DAMAGE TO RENTED 100,000 MED EXP AnY one ersen PERSONAL&ADV INJURY 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 3,000,000 POLICY 1:1% F-1 LOG PRODUCTS COMPIOP AGG $ 1,000,000 OTHER; H&NO Auto 11000,000 B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Es accide ) ANY AUTO AW6D229198 04/18/2017 0411812D18 BODILY INJURY Per person) OWNED SCHEDULED AUTOS ONLY x AUUTO$$ BODILY INJURY Per accfdent $ AU OS ONLY All OS phiLOY PPorr aERfdent AMAGE $ UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAS CLAIMS-MADE AGGREGATE DED I J RETENTION$ PE C WORKERS COMPENSATION _ STA[1TE._.,,f 0TH- AND EMPLOYERS' YIN LIABILITY WCV801303900 0110112018 01/0112019 500,000 ANY PROPRIETORIPARTNERIEXECUTIVE MCA E.L.EACH ACCIDENT $ OFFICERIMEMBE EXCLUDED? {Mandatory In N E.L.DISEASE-EA EMPLOYE 5'00'000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT A AbuselSex Molestatio MLP 627939594 003 0110112018 0110112019 iPer Claim 1,000,000 A Prof Liability MLP 627939594 003 0110112018 01/0112019 Per Aggregate 3,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 141,Additional Remarks Schedule,may he attached It more apace Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County Department of Social Services THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 tS P ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 8181 Hillsborough,NC 27278 AUTHORIZED REPRESENTATIVE ACORD 25(2016103) O 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD