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2019-702-E DSS - Personalized Patient Home Assistance Inc in home aide services
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2019-702-E DSS - Personalized Patient Home Assistance Inc in home aide services
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Last modified
10/18/2019 2:34:24 PM
Creation date
10/7/2019 2:06:07 PM
Metadata
Fields
Template:
Contract
Date
9/30/2019
Contract Starting Date
7/1/2019
Contract Ending Date
6/30/2020
Contract Document Type
Contract
Amount
$253,600.00
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R 2019-702 DSS - Personalized Patient Home Assistance Inc in home aide services
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\Board of County Commissioners\Contracts and Agreements\Contract Routing Sheets\Routing Sheets\2019
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DocuSign Envelope ID:412EAE5F-3824-43FA-AC95-54AOC4DF83A2 <br /> ACC>R" CERTIFICATE OF LIABILITY INSURANCE DATE911W201YYVY) <br /> ��. 0911 01 0 19 <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 INSURER(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 provisions or be endorsed. <br /> If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on <br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT Carla Dubuc <br /> NAME: <br /> Sanford Insurance Center H NE Exs: (919)775-7216 �yj X No): (888)280-1597 <br /> (Af1722 S HORNER BLVD -MA L <br /> ADDRESS: <br /> INSURER{SyAFFORDING COVERAGE NAIL# <br /> SANFORD NC 27330 INSURERA: National Liability and Fire <br /> INSURED INSURERS: United States Liability Insurance 25895 <br /> Dorothea Farrington RBA INSURER C <br /> Personalized PatienIS Home Assistance INSURER D: <br /> 109 Concord Dr INSURER E <br /> Chapel Hill NC 2751E INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: CL1991005245 REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> WSR TYPE OF INSURANCE POL C ❑LICY EXP LIMITS <br /> LTR INSD WVD POLICY NUMBER M'MDDIYYYY MMIDDIYYYY <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,o00 <br /> ��,,// A 100,000 <br /> CLAIMS-MADE /'\ OCCUR PREMISES Ea occurrence $ <br /> MED EXP(Any one person) $ 5,OD0 <br /> B AH1565797B 07117/2019 07/17/2020 PERSONAL&ADV INJURY $ 1,000,000 <br /> P'OTHER; <br /> LAGGREGATE LIIMITAPPLIES PER: GENERAL AGGREGATE $ 3,000,000 <br /> POLICY JECT LOC included <br /> PRODUCTS-COMPIOPAGG $$ <br /> COMBINED SINGLE LIMIT <br /> AUTOMOBILE LIABILITY Ea accldeni $ <br /> ANY AUTO BODILY INJURY{per person) $ <br /> CWNE❑ SCHEDULED BODILY INJURY(Per accldenl) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per aocadent <br /> $ <br /> UMBRELLA LLAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> ❑E❑ RETENTION$ r $ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY Y'" STATUTE I ER <br /> 10a,000 <br /> ANY PROPR CEWMEMB RIPAR-UDEDxECUTIVE E.L.EACH ACCIDENT $ <br /> p' ❑FFiCER1MEMeER EXCLUPEO7 ❑ H IA A9WC9&7430 07/05/2019 07/0512020 100,D00 <br /> {Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under 500,D00 <br /> DESCRIPTION!OF OPERATIONS bald E.L.DISEASE:-POLICY LIMIT $ <br /> Each Claim 1,000,000 <br /> Allled Healthcare Professional Liability <br /> B Abuse/Molestation AH 1555797B 07/17/2019 07/17/2020 Aggregate 3,000,000 <br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is 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 /> Orange County OSS ACCORDANCE WITH THE POLICY PROVISIONS. <br /> PO Box 8181 <br /> AUTHORIZED REPRESENTATIVE <br /> Hillsborough NO 27278 /C <br /> D 1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD <br />
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