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DocuSign Envelope ID:B92DDOFA-B451-4722-ACC3-D65CAA5BDAEC
<br /> E(MM/DDNYYY)
<br /> �`� CERTIFICATE OF LIABILITY INSURANCE DAT2/3/2020
<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 be endorsed. If SUBROGATION IS WAIVED,subject to
<br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br /> certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT
<br /> NAME: Margie La azon
<br /> Miller&Miller Insurance Agency Inc PHONE FAX
<br /> 720 Commerce Street o • 914-741-6400 A/C No):914-741 6407
<br /> Thornwood NY 10594 ADDRESS: MargieL@Miller-ins.com
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURER A:ACE AMERICAN INSURANCE COMPANY 22667
<br /> INSURED PREM1 4 INSURERS:National Continental Ins 10243
<br /> Premier Home Health Care Services Inc 1 North Lexington Ave, S#200 INSURER c:COVERYS SPECIALTY INSURANCE COMPANY 15686
<br /> White Plains NY 10601 INSURER D:CHARTER OAK FIRE INS CO 25615
<br /> INSURER E:TRAVELERS IND CO 25658
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 1186629551 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 /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> INSR ADDLSUBRTYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDPOLIDY/YYYY MMIDD/YYYY LIMITS
<br /> LTR
<br /> A GENERAL LIABILITY MLPG28210851004 2/2/2020 2/212021 EACH OCCURRENCE $1,000.000
<br /> DAMAGE X COMMERCIAL GENERAL LIABILITY PREM SESOEa occu ence $50,000
<br /> CLAIMS-MADE F_x1 OCCUR MED EXP(Any one person) $5,000
<br /> X PROF-CLAIMS MADE PERSONAL&ADV INJURY $1,000,000
<br /> X SEXUALABUSE GENERAL AGGREGATE $3,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $1,000,000
<br /> POLICY PRO LOC Prof Aggregate Limit $3,000,000
<br /> B AUTOMOBILE LIABILITY CNY00070829938 212/2020 2/2/2021 COMBINED SINGLE LIMIT
<br /> Ea accident $1,000,000
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS AUTOS
<br /> XIHIREDAUTOS X AUTOS�ED PeOraccid accident)DAMAGE $
<br /> I
<br /> C X UMBRELLA LIAB OCCUR 005NY000025117 2/2/2020 212/2021 EACH OCCURRENCE $1,000,000
<br /> EXCESS LIAB I V1 I CLAIMS-MADE AGGREGATE $1,000,GOD
<br /> DED I X I RETENTION$10000 SEXUALABUSE $1,000,D00
<br /> D WORKERS COMPENSATION N UBON2530781951K 6/30/2019 6/30/2020 X WC STATU- OTH-
<br /> E AND EMPLOYERS'LIABILITY Y/N UB9M8461691951 R 6/30/2019 6/30/2020 1 TORY LIMITS ER
<br /> ANY OFFICER/MEMBER EXCLUDED?PROPRIETOR/PARTNER/EXECUTIVE� N/A E.L.EACH ACCIDENT $1,000,000
<br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required)
<br /> *Policies shown are subject to terms,conditions,exclusions,sublimits and deductibles not listed on this certificate. We recommend that requests for policy
<br /> copies be directed to the Named Insured shown above.*
<br /> Work Comp Policy #UBON2530781951 K-Covers the following States-CT,GA,,IL, MA, NJ,NY,NC,OK
<br /> Work Comp Policy# UB9M8461691951 R -Covers the following States-FL,MA
<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 /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Orange County Dept of social Services
<br /> 113 Mayo Street AUTHORIZED REERESENTATIVE
<br /> Hillsborough NC 27278
<br /> ©1988-2010 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD
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