2020-890-E Social Svc - HRC Behavioral Health & Psychiatry virtual therapy group

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--DocuSign Envelope ID: DCOCOA1 D-1 C9B-41 B9-9927-4B65B9A4A5C4 --- -" -- 1 ® DATE(MM/DD/YYYY) ACCORD CERTIFICATE OF LIABILITY INSURANCE ��. 8/28/2020 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAMEACT Audrey Williams Marsh&McLennan Agency LLC P HO NE 2301 Sugar Bush Road AMA Ext:919-878-9412 n!c No IL Suite 600 ADDRESS: audre .williams MarshMMA.com Raleigh NC 27612 INSURERS AFFORDING COVERAGE NAIC# INSURER A: Hanover American Insurance Company 36064 INSURED HRCBEHAV INSURER B:All America Insurance Company 20222 HRC Behavioral Health& Psychiatry, PA INSURER C 100 Europa Drive,Suite 260 INSURER D: Chapel Hill NC 27517 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1188818937 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 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. INSR ADDL SUER POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD WV13 POLICY NUMBER MM/DD MM/DD A COMMERCIAL GENERAL LIABILITY OZ6H211843 3/31/2020 3/31/2021 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES Ea occurrence $1,000,000 X Businessown Liab MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 FqPOLICY PRO ❑ LOG PRODUCTS-COMP/OP AGO $ JECT OTHER: CO ED AUTOMOBILE LIABILITY (Ea accidentSINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS DAMAG HIRED NON-OWNED PR0PERTYE $ AUTOS ONLY AUTOS ONLY Per accident A X UMBRELLA LIAB X OCCUR OZ6H211843 3/31/2020 3/31/2021 EACH OCCURRENCE $1,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $1,000,000 DED RETENTION$ $ B WORKERS COMPENSATION W26H20387100 3/31/2020 3/31/2021 X STATUTE ERH AND EMPLOYERS'LIABILITY Y I N ANYPROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Orange County Department of Social Services 133 Mayo St AUTHORIZED REPRESENTATIVE Hillsborough NC 27278 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD