2021-004-E Social Svc - Chapel Hill Outreach project Cardinal Managed Care

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DocuSign Envelope ID: D90F57F1-8076-4358-9941-F62552053F84 Client#:929075 20CHAPEHIL3 [DATE(MM/DDfYYYY) ACORD,., CERTIFICATE OF LIABILITY INSURANCE 08/17/2020 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 INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(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 holder in lieu of such endorsement(s). PRODUCER CONTACT NAME; Beth Wilkerson McGriff Insurance Services ,C' Ext:919 281-4500 NC,N. 888 746-8761 Post Office Box 13941 ADDRlEss: NCCertificateTeam(a mcgriffinsurance.com Durham,NC 27709 INSURER(S)AFFORDING COVERAGE NAIC# 919 281-4500 INSURER A:Philadelphia Indemnity Insurance Co. 18058 INSURED INSURER B:Accident Fund Ins Co of America 10166 Chapel Hill Training Outreach Project INSURER C Inc INSURER D 800 Eastowne Dr,Ste 105 INSURER E Chapel Hill,NC 27514 INSURER F 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 OR CONDITION 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. TR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDD/YEYYY MM/OPOUCOIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY PHPK2094162 2/05/2020 02/05/2021 EACH OCCURRENCE $1 000000 CLAIMS-MADE �OCCUR PREMISESOEaoccurrDenca $1 OOO,OOO MED EXP(Any one person) s 20,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 PRO- POLICY❑JECT LOG PRODUCTS-COMPIOPAGG $3,000,000 OTHER: $ A AUTOMOBILE LIABILITY PHPK2094162 2/05/2020 02/05/2021 ECOMBINED ccideISINGLE LIMIT $1,000,000 IX ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS $HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY X AUTOS ONLY Per accident A X UMBRELLA LIAB X OCCUR PHUB710568 2/0512020 02/05/2021 EACH OCCURRENCE $1 OOO 000 EXCESS LIAB CLAIMS-MADE AGGREGATE $1 000 000 DED I X RETENTION$10000 $ B WORKERS COMPENSATION WCV6096247 12/17/2019 12/17/2020 X PER ITI Eli AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE Y/N E.L.EACH ACCIDENT $500 000 OFFICER/MEMBER EXCLUDED? N WA A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500 OOO If yes,describe under DESCRIPTION OF OPERATIONS below _ E.L.DISEASE-POLICY LIMIT $500,000 A Professional Liab PHPK2094162 2/0512020 02/05/2021 $1,000,000/$3,000,000 A Abuse/Molestation PHPK2094162 2/05/2020 02/05/2021 $1,000,000/$3,000,000 A C ber Liability PHSD1519902 2/05/2020 02/05/2021 $1,000,0001$2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached If more space is required) Certificate Holder is included as Additional Insured,per written contract,as their interest may appear CERTIFICATE HOLDER CANCELLATION Orange Count Government SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 9 Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn:Risk Manager ACCORDANCE WITH THE POLICY PROVISIONS. PO BOX 8181 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 #S26342463/M25156989 AB4