2019-668-E DSS - Medisolutions in home aide services

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DocuSign Envelope ID: 12D946D0-9D14-4754-B762-26F971E30A53 T r1l TE(MM(ODNYYY] A�a CERTIFICATE OF LIABILITY INSURANCE 210 312 0 1 8 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 jINSURANCE DOES NOT-CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERtS), 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). CONTAC T n PRODUCER PHON� Angie Cox 9 ,__,._,_._.� QH°HE 919-571-0685 FAQ 919)571-0684 Capital Insurance& Financial Services,Inc. .,iglC�„�g,£� _— _ �_...._.,�, �_�____ 3701 Lake Boone frail EA,goREs : acox capital-Ins.com _ Suite 200 - __. INSURER S}AFFORDING GOVERAGE NAlC p Ralei h NC 27607 INSURER A: Philadelphia Insurance Companies INSURED INSURER IB: Travelers Medlsolutions Inc INSURER C: 1146 N Church St INSURER D INSURER E: BURLING70N NG 27217 INSURERr-: COVERAGES CERTIFICATE NUMBER: 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 ❑R 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. iNff AUW tiUUR POLICY FF PDLI P LIMITS LTR TYPE OF INSURANCE POLICY NUMaER MMrUD1YYYY lNMIDOIYYYY GENERAL LIABILITY EACH OCCURRENCE S 1000000 µ COMMERCIAL GENERAL LIABILITY PREMISES Ea we rence S 100000 _ CLAIMS-MADE Ix OCCUR MED E7CP(AnyanepBrsan} A N N PHPK1742845 11122t2018 11/22/2019 PERSONAL$ADV INJURY S 1000000 M GENERAL AGGREGATE S 2000000 GENT AGGREGATE LIMIT APPLIES PER; PRODUCTS-COMPIOP AGG s 2000000 ?{ POLICY PRo F1Lac Sexual/Phvsical Abuse s 1000000 AUTOMOBILE LIABILITY COM9INED SINGLE LIMI $ BODILY INJURY(Pe(person} 5 ANY AUTO ALL Ok VED SCHEDULED' BODILY INJURY(Per accident) $ AUTOS AUTOS INON-OWNED! I D D AAfuf QE m a HIRED AUTOS AUTOS rPe.a 'dent] i � 5 UMBRELLA LIAR OCCUR EACH OCCURRENCE S E __ EXCESS LIAR HCLANS-MADE I AGGREGATE $ I DED RETENTION 5 f $ WORKERS COMPENSATION X I WC STATU- I IOTH. �AN 0 EMPLOYERS'L IAB ILI TY .TL�IRY LIMI T ANY PRO PRIETORIPARTNERIEXECVTIHE Y r N E.L.EACH ACCIDENT s 104fl04 $ OFFICEFUMEMBER EXCLUDED? !Y NIA- N U13 i K06127: 11/29/2018 11/29/2019 -' (Mandatory In NH) E-L.DISEASE-EA EMPLOYEE S 100000 If describe under E.L.CI EASE-POLICY LIMIT S 500000 OLSE.,CRlPTIEiN OF Ci'E RAT lONS below S E Professional Liability 1,000,000 each occurrence A I N N PHPK174845 11/22/2019 11f2212019 2,D00,400 aggregate DESCRIPTION OF OPERATIONS ILOCATIONS I VEHICLES(Altacti ACORD 70f4 Additional Remarks Schedule,if more space Is required) ' I i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WLL BE DELIVERED IN Orange Co u nty Governm ent ACCORDANCE WITH THE POLICY PROVISIONS, 113 Mayo S1 AUTHORIZED REPRESENTATIVE Hillsborough NC 27278 ACORD 25(2010105) ©1988-2010 ACORD CORPORATION.All rights reserved, The ACORD name and fogs are registered marks of ACOR❑