2018-585-E DSS - Senior Care-Solyts adult care

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DocuSign Envelope ID:AA69FB9A-1A2E-426C-AC90-FAA292CFBF41 Client#:955852 04SEN IOCA R1 DATE(MMIDDIYYYY) ACORDT� CERTIFICATE OF LIABILITY INSURANCE 06/2912018 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 any rights to the certificate holder In lieu of such endorsement(s). CONTACT PRODUCER - NAME: McGriff Insurance Services PHONo 888 743-2217 8888278861 A7C N E Ext: AIC No 414 Galiirnore Dairy Road E-MAIL ADDRESS: Suite F INSURER(S)AFFORDING COVERAGE NAIL 4 Greensboro,INC 27409 INSURER A:F+...tunlnsumn"C"I""y 35378 INSURED INSURER B:Markellnsu aneeCampany 38970 Senior Care of Orange County Inc INSURER C: Attn Day Health Center INSURER n 105 Meadowlands Dr INSURER E: Hillsborough, NC 27278-8181 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 CONTRACTOR 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 ADDLSUB -POLICYEFF POLICYEXP LIMITS LTR TYPE OF INSURANCE INSR WVO POLICY NUMBER IMMIDDIYYYY MMIDDFYY'fY A X COMMERCIAL GENERAL LIABILITY x SM921051 07113/201810711312019 EACH OCCURRENCE $1,000,000 X CLAIMS-MADE ❑OCCUR RREMI5 5 Eaoccurre.,W $50,000 X BI/PD Ded:S 400 MED EXP(Any arle person) $5 444 PERSONAL&ADV INJURY $110001000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3'004,404 PR0. PRODUCTS-COMPIOP AGG $ POLICY❑JECT LOC $ OTHER: - - COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea acclden! ANY AUTO 9001 L INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accfdenl S UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ OED I I RETENTION$ $ - B WORKERS COMPENSATION MWC010610202 0210812018 0210812019 X I PER 1 11 oTH- AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE Y I N NIA E.L,EACH ACCIDENT $500,000 OFFICERIMEMBER EXCLUDED? (Mandatary In NH) E.L.DISEASE-EA EMPLOYEE s500,000 If es,describe under E.L-DISEASE-POLICY LIMIT $504,440 DESCRIPTION OF OPERATIONS below A Professional SM921051 0711312018 0711312019 $1,000,000 each claim Liability $3,000,000 aggregate $5,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additlonat Remarks Schedule,may be attached If more space Is required) Policy includes endorsement that provides Additional Insured status for any Landlord,Owner,or Property Manager of the Designated Premises or any Tradeshow or Convention Sponsor or operator or any lessor of equipment. Professional Liability-Pol.#SM921061 (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION Orange t'.+3Un Government SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 S Cameron Street ACCORDANCE WITH THE POLICY PROVISIONS. Hillsborough,INC 27278 AUTHORIZED REPRESENTATIVE C 1988-2415 ACORD CORPORATION.All rights reserved. ACORD 2.5(2016103) 1 of 2 The ACORD name and logo are registered marks of ACORD #S204711011M20467370 WH9