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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 />INSURER(S) AFFORDING COVERAGE
<br />INSURER F :
<br />INSURER E :
<br />INSURER D :
<br />INSURER C :
<br />INSURER B :
<br />INSURER A :
<br />NAIC #
<br />NAME:CONTACT
<br />(A/C, No):FAX
<br />E-MAILADDRESS:
<br />PRODUCER
<br />(A/C, No, Ext):PHONE
<br />INSURED
<br />REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<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 />OTHER:
<br />(Per accident)
<br />(Ea accident)
<br />$
<br />$
<br />N / A
<br />SUBR
<br />WVD
<br />ADDL
<br />INSD
<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 />$
<br />$
<br />$
<br />$PROPERTY DAMAGE
<br />BODILY INJURY (Per accident)
<br />BODILY INJURY (Per person)
<br />COMBINED SINGLE LIMIT
<br />AUTOS ONLY
<br />AUTOSAUTOS ONLY NON-OWNED
<br />SCHEDULEDOWNED
<br />ANY AUTO
<br />AUTOMOBILE LIABILITY
<br />Y / N
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />DESCRIPTION OF OPERATIONS below
<br />If yes, describe under
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />$
<br />$
<br />$
<br />E.L. DISEASE - POLICY LIMIT
<br />E.L. DISEASE - EA EMPLOYEE
<br />E.L. EACH ACCIDENT
<br />EROTH-STATUTEPER
<br />LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />EXCESS LIAB
<br />UMBRELLA LIAB $EACH OCCURRENCE
<br />$AGGREGATE
<br />$
<br />OCCUR
<br />CLAIMS-MADE
<br />DED RETENTION $
<br />$PRODUCTS - COMP/OP AGG
<br />$GENERAL AGGREGATE
<br />$PERSONAL & ADV INJURY
<br />$MED EXP (Any one person)
<br />$EACH OCCURRENCE
<br />DAMAGE TO RENTED $PREMISES (Ea occurrence)
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS-MADE OCCUR
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY PRO-JECT LOC
<br />CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
<br />CANCELLATION
<br />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2016/03)
<br />© 1988-2015 ACORD CORPORATION. All rights reserved.
<br />CERTIFICATE HOLDER
<br />The ACORD name and logo are registered marks of ACORD
<br />HIRED
<br />AUTOS ONLY
<br />9/29/2023
<br />Commercial Insurance Associates,LLC
<br />103 Powell Court,Ste 200
<br />Brentwood TN 37027
<br />Kelly Creekmore
<br />615-515-6023 615-515-6001
<br />kcreekmore@com-ins.com
<br />Sentinel Insurance Co Limited 11000
<br />PRIMHEA-01 Accident Fund Insurance Company of America 10166PrimeHealthServices,Inc.
<br />331 Mallory Station Rd.
<br />Brentwood TN 37067
<br />Capitol Specialty Insurance 10328
<br />Houston Casualty Company 42374
<br />1129979607
<br />A X 1,000,000
<br />X 1,000,000
<br />10,000
<br />1,000,000
<br />2,000,000
<br />X
<br />20SBAZT7851 6/17/2023 6/17/2024
<br />2,000,000
<br />A 1,000,000
<br />X X
<br />20SBAZT7851 6/17/2023 6/17/2024
<br />A X X 6,000,00020SBAZT78516/17/2023 6/17/2024
<br />6,000,000
<br />X 10,000
<br />B XAFWCP1000295706/17/2023 6/17/2024
<br />1,000,000
<br />1,000,000
<br />1,000,000
<br />C
<br />A
<br />D
<br />Professional Liability
<br />Property
<br />Cyber
<br />MC2022102202
<br />20SBAZT7851
<br />H23NGP223091-00
<br />5/1/2023
<br />6/17/2023
<br />3/2/2023
<br />5/1/2024
<br />6/17/2024
<br />5/1/2024
<br />Per Claim/Aggregate
<br />Contents
<br />Cyber
<br />5,000,000
<br />2,205,800
<br />5,000,000
<br />Excess Professional Liability Policy No:MXO13741044501;Homesite Insurance Effective 5/1/2023-5/1/2024 ;$2,000,000 Limit
<br />General Liability,Hired &Non-Owned Auto Liability,and Employer's Liability are underlying coverages with respect to the above referenced Umbrella Policy.
<br />Orange County,its officers,agents,and employees are included as additional insureds as required by written contract with the Named Insured on the
<br />referenced General Liability.
<br />Orange County
<br />300 West Tryon Street
<br />PO Box 8181
<br />Hillsborough NC 27278
<br />DocuSign Envelope ID: CC7A4A66-ACFF-408E-A299-938E0666EA49
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