2019-478-E DSS - Carolina Outreach counseling services

Browse Search

DocuSign Envelope ID:987EC3F6-E183-4CB2-9D96-063C8A864FOC Client#: 1667554 35NCGCAR ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 3/0812019 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 INSURERIS),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT.If the certificate holder is an ADDITIONAL INSURED,the pollcy[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 haIder in lieu of Such endorsements). PRODUCER CONTACT Vivian Hume NAME: McGriff Insurance Services PHONE 804 fi78-5000 °X 888 751-3010 A1C Na Ext: 'AC, C No; 2108 W.Laburnum Ave Suite 300 a-MAIL ADDRESS: PO Box 17370 INSURtiR(S)AFFORDING COVERAGE NA4C M Richmond,VA 23227 INSURER A PhlladrphInIndemnity nce lnaurnCo. 18058 INSURED 40045 Carolina Outreach LLC INSURER c; PO Box 11247 INSURER D: Richmond,VA 23230 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAME ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CON➢MON 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. IN EXP R TYPE OF INSURANCE I NR ysyUryep POLICY NUMBER MMIDQY EFF MMIPCCY LIMITS A X COMMERCIAL GENERAL LIABILITY PHPK1882152 10101/2018 10101/20ig EEAAC�HH OCCE1'1CURRENCE $1 000 OOO CLAIMS-MACE �OCCUR PREMISS cu ence $1 000 000 MED EXP(Any one erson) $5,000 PERSO NAL&ADV INJURY $1000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 PRO- LOC PRODUCTS-COMPIOP AGG s3,000,000 POLICY JECT OTHER: $ EII- A AUTOMOBILE LIABILITY PHPK1882152 10/01/2018 10/011201 F,M�d,.,1 91NGLELIMIT 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(PerawIdent) $ AUTOS ONLYE AUTOSHIRED NON-OWNED PROPERTY DAMAGE $ x AUTOS ONLY AUTOS ONLY P®r accident A x UMBRELLA LIAB I)C OCCUR PHUB647596 0/0112018 10/01/201 EACHOCCURRENCE $15000000 EXCESS LIAR CLAIMS-MADE AGGREGATE $15 000 000 DER I x RETENTION$20.000 $ B WORKERS COMPENSATION KEY0137631 1010112018 10101/2019 x ISTERATU17FI IOTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOWPARTNERIEXECUTIVE Y!H EL.EACH ACCIDENT $1 000 000 O7=FICERWEMB€R EXCLUDED? N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1 d0O 000 H yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1 000 000 A Professional Liab PHPK1882152 10/0112018 1010112014 $1,000,000 Each Incidnt $3,000,000 Aggregate AbuselMolestation PHPK1882152 11010112018 1010112019 $10000000ccIS20000GOAgg ❑ESCRIPTION OF OPERATIONS+LOCATIONS f VEHICLES(ACORO 101,Add IEIonaI Remarks Scheduia,may bo attachad if more space is required) CERTIFICATE HOLDER CANCELLATION Orange Coon SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 9 County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 113 Mayo Street ACCORDANCE WITH THE POLICY PROVISIONS. Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) 1 of 1 The ACORD name and logo are registered marks of ACORD #S230832711M23083215 VRH