2018-668-E Health - Planned Parenthood professional services agreement

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DocuSign Envelope ID:32C22978-D1B8-4515-AD1A-21853E88FAA8 �T a DATE(MM/DDIYYYY) ��. CERTIFICATE OF LIABILITY INSURANCE 09/06/2018 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 CONTACT Marsh USA,Inc. NAME: PHONE FAX 1166 Avenue of the Americas A/C No Ext: A/C No), New York,NY 10036 E-MAIL Attn:healthcare.accountscss @marsh.com Fax:212-948-1307 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# CN1 01357758-NIP-CAS-1 8-19 ROA,V GLUM INSURER A:New Hampshire Insurance Company 23841 INSURED INSURER 13:N/A N/A PLANNED PARENTHOOD SOUTH ATLANTIC AN AFFILIATE OF PLANNED PARENTHOOD INSURER C, FEDERATION OF AMERICA,INC. INSURER D: 2207 PETERS CREEK ROAD ROANOKE,VA 24017 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: NYC-010345501-01 REVISION NUMBER: 3 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICYNUMBER MM/DD/YYYY MM/DDIYYYY A X COMMERCIAL GENERAL LIABILITY 082695195 01/01/2018 01/01/2019 EACH OCCURRENCE $ 1,000,000 DAMAGE CLAIMS-MADE � OCCUR PREM REMISES(Ea a occur',nte $ 500,000 X SIR:$100,000 MED EXP(Any one person) $ Included PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑ PRO- POLICY [X] LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident X UMBRELLALIAB X OCCUR 086396874 01/01/2018 01/01/2019 EACH OCCURRENCE $ 3,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 3,000,000 DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below ___,E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:CLINICIANS WITH OCHS WILL BE PERFORMING VASECTOMIES AT OUR SITES AS PER CONTRACT. ORANGE COUNTY HEALTH DEPARTMENT IS INCLUDED AS ADDITIONAL INSURED WHERE REQUIRED BY WRITTEN CONTRACT WITH RESPECTS TO GENERAL LIABILITY. CERTIFICATE HOLDER CANCELLATION ORANGE COUNTY HEALTH DEPARTMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ATTN:PAM MCCALL THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 300 W TRYON STREET ACCORDANCE WITH THE POLICY PROVISIONS. HILLSBOROUGH,VA 27278 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Ricki Fitzsimmons ',_ ,. - .—_. ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD