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

Browse Search

DocuSign Envelope ID: DCOCOA1D-1C9B-41B9-9927-4B65B9A4A5C4 I CERTIFICATE OF LIABILITY INSURANCE /DDIYYYY) ACQRO DATE(MM ��- 1 11/05/2020 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($). CONTACT PRODUCER NAME:Trust Risk Management Services,Inc Trust Risk Management Services, Inc. doing business in NC PHONE FAX (A/C,No,Ext):877.637.9700 (A/C,No):877,251.5111 as Potomac Risk Management Services, Inc. EMAIL 1791 Paysphere Circle ADDRESS:lnfo@trustrms.co Chicago, IL 60674 INSURER S)AFFORDING COVERAGE NAIC# INSURER A:ACE American Insurance Company 22667 INSURED INSURER B: Charles Holton INSURER C: 100 Europa Dr Ste 260 INSURERD: Chapel Hill, NC 27517-2394 INSURER E: 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 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 SUSR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED $CLAIMS MADE 1-1OCCUR PREMISES(Ea occurrence) MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO- PRODUCTS—COMP/OP AGG $ POLICY 1-1 PRO- ❑LOC HOTHER: COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY Ea accident ANY AUTO BODILY INJURY(Per Person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS F AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ $ DED RETENTION$ WORKERS COMPENSATION PER OTH- $ AND EMPLOYERS LIABILITY STATUTE ER YIN N E.L.EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A $ OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE (Mandatory in NH) $If yes,describe under E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS below Psychologist's Professional Liability 78G22448663 08/01/2020 08/01/2021 Each Incident $2,000,000 A Retroactive Date 12/01/1999 Annual $4,000,000 Aggre ate DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Orange County Department of Social Services BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE 133 Mayo St DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD