2017-703-E Health - National Assn of State Mental Health Directors service agreement

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DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E AC[]R" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) F,010/216/2017 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 endorsements . PRODUCER CONTNAME: Benita Williams NFP Property&Casualty Services, Inc. PHONE 301-628-4191 FAx 301-628-4001 3915 National Drive, Suite 400 AIC "° Burtonsville MD 20866-1126 ADDRESS:benita.williams@nfp.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:National Fire Insurance 20478 INSURED NASMH-1 INSURER B:Travelers Cas Ins Co of Americ 19046 NASMHPD Research Institute, Inc. INSURER C:Continental Insurance Co. 35289 3141 Fairview Park Dr., Suite 650 Falls Church VA 22042 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 183642496 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 TYPE OF INSURANCE A L B POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY B 6011149667 7/1/2017 7/1/2018 EACH OCCURRENCE $2,000,000 CLAIMS-MADE �X OCCUR PREM SESOEa oNcurrDence $300,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 X POLICY❑ PRO- JECT ❑ LOC PRODUCTS-COMP/OP AGG $4,000,000 OTHER: $ A AUTOMOBILE LIABILITY B 6011149667 7/1/2017 7/1/2018 COMBINED SINGLE LIMIT $ Ea accident 1,000,000 ANY AUTO BODILY INJURY(Per person) $ AUTOS NED SCHEDULED BODILY INJURY(Per accident) $ AUTOS X HIRED AUTOS F NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ "/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B D&O/EPLI/E&O/FID 105621398 8/1/2017 8/1/2019 Limit $1,000,000 C Network Security/Privacy Liabilit 6011149653 7/30/2017 7/30/2018 Limit $1,000,000 A Employee Dishonesty/Theft B 6011149667 7/1/2017 7/1/2018 Limit $250,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County Health Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn:Mark O'Donnell ACCORDANCE WITH THE POLICY PROVISIONS. 200 S.Cameron Street P.O. Box 8181 Hillsborough NC 27278 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD