2021-640-E-Aging-Senior Care of Orange-Adult Day care

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DocuSign Envelope ID:9F8945D7-E616-45A2-816D-12F64FB659FF Client#:955852 04SENIOCAR1 ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 07/14/2021 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: McGriff Insurance Services PHONE 888 743-2217 8888279861 A/C No EM: A/C No 7701 Airport Center Dr E-MAIL Suite 1800 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Greensboro, NC 27409 INSURER A:Evanston Insurance Company 35378 INSURED Senior Care of Orange County Inc INSURER B:Markel Insurance Company 38970 C/O Dawniell Boykin INSURER C: 105 Meadowlands Dr INSURER D: Hillsborough, NC 27278-8500 INSURERE: 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. INS ADDL SUBR POLICY EFF POLICY EXP LTRTYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DDIYYYY MMIDD LIMITS A X COMMERCIAL GENERAL LIABILITY SM936853 7/13/2021 07/13/2022 EACH OCCURRENCE $1 00U 000 X CLAIMS-MADE OCCUR PREMISES EaENTED occurrence) $50,000 X BI/PD Ded:5,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 PRO X POLICY _JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident I ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEO RETENTION$ $ B WORKERS COMPENSATION MWC010610205 2/08/2021 02/08/202 XPER OTH- AND EMPLOYERS'LIABILITY Y/N T _.,_.__....__ ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $500 000 OFFICER/MEMBEREXCLUDED? 5y] N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE s500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 A Professional SM936853 0711312021 07/13/202 See description Liabitiliy DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Miscellaneous Coverage-Professional Liability-Pol.#SM936853 Professional Liability Limit#1: 1,000,000 Ded.#1: $5,000.00 Limit#2:3,000,000 Retroactive Date:July 13,2005 for GL and PRO (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION Orange County Government SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS. Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE ' tUnt" ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) 1 of 2 The ACORD name and logo are registered marks of ACORD #S28393862/M28393830 SPLES