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DocuSign Envelope ID: FBCC2048-2774-4750-9EA4-440DA53C487A <br /> DocuSign Envelope ID:A07C4620-D9F0-4228-9B2F-117499E5F8796 <br /> =(MWYY)CERTIFICATE OF LIABILITY INSURANCE <br /> This CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS <br /> CERTIFICATE DOES MOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING iNS1,11RER(S),AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy{ies]must have ADDITIONAL INSURED pro visions or be endorsed. <br /> if SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certaln polloles may require an endorsement, A statement on <br /> this certificate does not confer rights to the certificate holder in ileu of such endorsement[s], <br /> CONTACT Carla Dubuc <br /> PRODUCER NAME: <br /> P O E Fax t y <br /> BB8 AIC Not 28D-1597 <br /> Sanrord insurance CeRter Nv ExS �919j 775'7218 <br /> E-MAIL <br /> 1722 S HORNER BLVD ADDRESS: <br /> INSURERIS]AFFORDING COVERAGE NAIL# <br /> SANFORD NC 27330 INSURERA; National Liability and Fire <br /> INSURED INSURER B 1 <br /> Personalized Patients Home Assistance,0BA:Dorathea Farrington INSURER C <br /> 70g Concord Or INSURER D: <br /> INSURER E <br /> Chapal HIII NC 27516 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: CLIB7904847 REVISION NUMBER: <br /> THIS <br /> CE A D. NOTTWITH TAND N EQ G ANY RUIREMENT,TERM OR CONDIT T <br /> ION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO THE INSURED NAMED ABOVE FOR THE L <br /> ICY PERIOD <br /> N WHICH THIS <br /> CERTIFICATE MAY BE ISSUED 0R MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SVBJECTToALLTHE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> AIJUL <br /> PO ICY EFF POLICY EXP LIMITS <br /> IL7R L. <br /> TYPE OF INSURANCE ipgD y,N❑ POLICYNVMBER MM70D MMEDRMn <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S <br /> DAMAGE T7lM74TeT-- <br /> CLAIMS-MADE F OCCUR PREMISES Ea occurrence $ <br /> MED EXP(Any one Ps—') $ <br /> PERSONAL&AOV INJURY <br /> GENERALAGOREGATE S <br /> G EN'L AG GRFGATE LIMI T APP L I ES PER: <br /> PRO LOC PRODUCTS-COMPIOPACjQ $ <br /> POLICY❑JECT $ <br /> OTHER! £e COMBINED SINGLE LIMIT $ <br /> AUTOMOBILE LIABILITY neddiBODILY <br /> BODILY LY INJURY(Per person) $ <br /> ANYAUTO <br /> OWNED SCHEDULED BODILY INJURY(P a a"ldent) S <br /> AUTOS ONLY AUTOS PROPERTY DAMAGE $ <br /> HIRED NGN•OWNEC Aar acc`danl <br /> AUTOS ONLY AUTOS ONLY $ <br /> UMBRELLA LIAO OCCUR EACH OCCURRENCE $ <br /> S <br /> EXCESS LIRB CLAIMS-A1AOE AGGREGATE <br /> S <br /> DED RETENTION 3 <br /> WORKERS COMPENSAMON STATUTE ER <br /> AND EMPLOYERS'LIABILITY y I Ts E.L.EACH ACCIDENT $ 1 DO,fl00 <br /> A ANY PROPRIEiORIPARTNERIEXECUTiVE ❑ NIA A9WC987430 07/05/2019 07105I2019 100,Ona <br /> OFFICER MEMUER EXCLLIDED7 E,L,D35EASE-EA EMPLOYEE $ <br /> (Mandatory In NH) 500,000 <br /> II yes,describe under E. DISEASE-POLICY LIMIT $ <br /> DFSCRIPTION OF OPERATIONS below <br /> DESCRIPTION OF OPERATIONS I LOCATIONS!VEHIGLES(ACORD J01,Addlllonal Rernarkc Schedule,may be attached If more NP¢ce 19 required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE.EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE PDL{CY PROVISIONS, <br /> Orange CountY DSS <br /> PO Box 6181 AU THORRff2jEA REPRESENTATIVE <br /> HIIlsboraugh NC 27278 +J 4�4& <br /> ©1968-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD <br />