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DocuSign Envelope ID:75C616E5-76E4-43AA-986C-053F34F85F83 <br /> FORD- CERTIFICATE OF LIABILITY INSURANCE March s 2019 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS <br /> CERTIFICATE DOES NOT 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 1NSURER(S),AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER <br /> IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the polIcy(]as)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and <br /> conditions of the policy,certain policies may require an endorsement.A statement on this certlflcate does not confer rights to the certificate holder In lieu of <br /> such endersement(s). <br /> PRODUCER CONTACT <br /> NAME: David Vickie <br /> The Solutions Group PHONE FAX <br /> 2211 N.W. Military Hwy., Ste 211 (A/C,No.EA): 210 490-7200 WC.No): s66 847-7232 <br /> San Antonio, TX 78213 E-MAIL <br /> ADDRESS: <br /> INSURERS AFFORDING COVERAGE <br /> INSURED INSURER A:Accident Fund National Insurance Company <br /> Happy HomeCare Staffing, Inc. INSURERR: <br /> 6720 Pentecost Rd. INSURERC: <br /> Cedar Grove, NC 27231 INSURERD: <br /> NSURER E: <br /> COVERAGES <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY <br /> PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO <br /> WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO <br /> INSR P CY F EC VE POLL YEX <br /> LTR TYPE OF INSURANCE POLICY NUMBER DATE MMIDO DATE MMIDONY LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE <br /> t <br /> MERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one Rre) <br /> CLAIMS MADE 7 OCCUR MED EXP(Any one person) <br /> PERSONAL&ADV INJURY <br /> GENERAL AGGREGATE <br /> GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS—COMPIOP AGG <br /> POLICY PE LOC <br /> AUTCMCSILE LIABILITY COMBINED SINGLE LIMIT <br /> ANY AUTO (Ea accident) $ <br /> ALL OWNED AUTOS BODILY INJURY <br /> SCHEDULED AUTOS (Per persan) $ <br /> HIRED AUTOS BODILY INJURY <br /> NON-OWNED AUTOS (Per accident) $ <br /> EXCESS LIABILITY EACH OCCURRENCE $ <br /> OCCUR CLAIMS MADE AGGREGATE $ <br /> $ <br /> DEDUCTIBLE $ <br /> RETENTION $ $ <br /> WORKERS COMPENSATION AND WCV 6184299 0312612019 03/26/2020 1 TO 77mI ) <br /> EMPLOYERS'LIABILITY E.L.EA ACCIDENT $1,000,000 <br /> A E.L.DISEASE—EA EMPLOYEE $12000,000 <br /> E.L.DISEASE—POLICY UMiT $1,000,000 <br /> OTHER <br /> 0ESCR€PTICN OF OPERATIONILO CATION SIVEHiCLESIEXCLIJSIONS ADDED BY E MOO IRS EMENTISPECIAL PROVISIONS <br /> Company Contact: Lesa Kendrick <br /> CERTIFICATE HOLDER I x I A00171ONAL INSURED:INSURER LETTER CANCELLATION <br /> Orange County Social Services SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BE- <br /> PO Box 8181 FORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN <br /> Hillsborough, NC 27278 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> ACORD 25 (2010105) The ACORD name and ]ago are registered marks of ACORD <br />