OTHER-2022-040-FY2023 funding agreement between Orange County and Alliance Health

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DocuSign Envelope ID : OCOB9F3D-55C2-4OA0-8AE6 -844A8169688D / , ® DATE (MM/DD/YYYY) ,d►`coRn CERTIFICATE OF LIABILITY INSURANCE 7/8/2022 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 : Terri BOula Arthur J . Gallagher Risk Management Services , Inc . PHONE FAx A/C No Ext : 919-5824001 A/c No) : 919-847-3160 4700 Homewood Court, Suite 260 E -MAIL Raleigh NC 27609 -5732 ADDRESS : terri boulay@ajg . com INSURERS AFFORDING COVERAGE NAIC # INSURER A : Arch Specialty Insurance Company 21199 INSURED ALLIBEH-01 INSURER B : Philadelphia Indemnity Insurance Company 18058 r Alliance Health 5200 W . Paramount Parkway Suite 200 INSURER Cl : SummitPoint Insurance Company 15136 Morrisville NC 27560 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER : 1785585083 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 POLICY NUMBER MM DD EFF POLICY EXP LIMITS LTR A X COMMERCIAL GENERAL LIABILITY FLP005983306 7/1 /2022 7/1 /2023 EACH OCCURRENCE $ 3 , 000 , 000 DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES Ea occurrence $ 100 , 000 MED EXP (Any one person) $ 5 , 000 PERSONAL & ADV INJURY $ 3 , 000 , 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 6 , 000 , 000 PRO POLICY JECT ❑ LOC PRODUCTS - COMP/OP AGG $ 6 , 000 , 000 X OTHER: $ B AUTOMOBILE LIABILITY PHPK2432968 7/1 /2022 7/1 /2023 COMBINED SINGLE LIMIT $ 1 , 0003000 Ea accident X ANY AUTO BODILY INJURY (Per person ) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ I PERC WORKERS COMPENSATION WCS3010757 7/1 /2022 7/1 /2023 X AND EMPLOYERS' LIABILITY STATUTE EORH YIN 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 FLP005983306 7/1 /2022 7/1 /2023 Each Occurence $3 , 000 , 000 Claims Made Aggregate $ 6 , 000 , 000 Retro 7/1 /2012 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 BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Orange County Manager' s Office ACCORDANCE WITH THE POLICY PROVISIONS . 300 W . Tryon Street PO Box 8181 AUTHORIZED REPRESENTATIVE Hillsborough NC 27278 f ~ - - © 1988 -2015 ACORD CORPORATION . All rights reserved . ACORD 25 (2016/03 ) The ACORD name and logo are registered marks of ACORD