2021-158-E Social Services-AHB Center Behavioral Health and Wellness consultant

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DocuSign Envelope ID: �6F373526-8608-47C8-AA9D-FDDD57D0834F DATE(MM/DD/YYYY) ��. CERTIFICATE OF LIABILITY INSURANCE 10/07/2020 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 CONTACT NAME:Trust Risk Management Services,Inc PHONE FAX Trust Risk Management Services,Inc.doing business in NC as Potomac A/C,No,Ext:877.637.9700 A/C,No):877.251.5111 Risk Management Services,Inc. EMAIL ADDRESS:info@trustrms.com 1791 Paysphere Circle INSURER 5 AFFORDING COVERAGE NAIC# Chicago,IL 60674 22667 INSURER A:ACE American Insurance Company INSURED INSURER B: April Harris-Britt INSURER C: 3326 Durham Chapel Hill Blvd Bldg D INSURER D: Durham, NC 27707 6201 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 SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DDIYYYY) (MM/DDIYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS MADE ❑OCCUR DAMAGE TO RENTED $ PREMISES(Ea occurrence) $ MED EXP(Any one person) PERSONAL&ADV INJURY M'OTHER: L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO- PRODUCTS—COMP/OP AGG POLICY JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per Person) $ ALL OWNED SCHEDULED $ AUTOS AUTOS BODILY INJURY(Per accident HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Perr 1 1 $ accident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- $ STATUTE ER AND EMPLOYERS LIABILITY y I N ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ E.L.DISEASE-EA EMPLOYE $ (Mandatory in NH) If yes,describe under E.L.DISEASE-POLICY LIMI $ DESCRIPTION OF OPERATIONS below Psychologist's Professional 78G26127051 08/19/2020 08/19/2021 Each Incident $1,000,000 A Liability Annual $3,000,000 Retroactive Date:08/19/2003 Aggregate DESCRIPTION OF OPERATIONS/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 Orange County Government BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 8181 Hillsborough NC 27278 AUTHORIZED REPRESENTATIVE ACORD 25(2016103) ©1988-2015 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD