2022-225-E-Sheriff Dept-Southern Health Partners-Medical Services for Inmates

Browse Search

DocuSign Envelope ID: E9DOCDAB-7830-4405-94B8-CO2D52F79427 DATE(MM/DD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 76/14/2022 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: Jen Cassullo Arthur J. Gallagher Risk Management Services, Inc. PHONE FAX 200 Jefferson Park A/C No Ext: 973-921-8194 A/C No:973-921-2876 Whippany NJ 07981 ADDRESS: Jen cassullo@ajg.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Ironshore Specialty Insurance Co 25445 INSURED SOUTHEA-18 INSURER B:Westchester Surplus Lines Insurance Co 10172 Southern Health Partners 2030 Hamilton Place Boulevard, Suite 140 INSURERC: National Indemnity Company 20087 Chattanooga TN 37421 INSURER D:Crum&Forster Specialty Insurance Co 44520 INSURERE: Sunz Insurance 34762 INSURER F: COVERAGES CERTIFICATE NUMBER:1088821772 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DDIYYYY B X COMMERCIAL GENERAL LIABILITY G72568436 001 3/13/2022 3/13/2023 EACH OCCURRENCE $1,000,000 TED CLAIMS-MADE � OCCUR PREMISES(Ea o DAMAGE TO ccurrence) $100,000 MED EXP(Any one person) $0 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY❑ PRO- JECT ❑ LOC PRODUCTS-COMP/OP AGG $2,000,000 X OTHER: $ C AUTOMOBILE LIABILITY 73APS105001 3/13/2022 3/13/2023 COMBINED SINGLE LIMIT $1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident B UMBRELLA LIAB X OCCUR G72568424001 3/13/2022 3/13/2023 EACH OCCURRENCE $4,000,000 D SEO-117603 3/13/2022 3/13/2023 X EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000 DED RETENTION$ $ E WORKERS COMPENSATION WC053-00001-022 6/1/2022 6/1/2023 PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 A Professional Liability HC6CAB5JNNO02 12/13/2021 12/13/2022 Each Claim $1,000,000 Aggregate $5,000,000 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 BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ORANGE COUNTY JAIL 125 COURT STREET AUTHORIZED REPRESENTATIVE HILLSBOROUGH NC 27278 i L yk ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD