2025-488-E-Social Svc-Dalroyce Jones dba Life’s Angel Transportation-non-emergency medical transportation

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CERTIFICATE OF LIABILITY INSURANCE INSURED PRODUCER (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below TYPE OF INSURANCE COMMERCIAL GENERAL LIABILITY CLAIMS-MADE X OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: X PRO- JECT POLICY OTHER: LOC AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY SCHEDULED AUTOS NON- OWNED AUTOS ONLY UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS-MADE DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBEREXCLUDED?N / A POLICY NUMBER INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : CONTACT NAME: PHONE (A/C, No, Ext): E-MAIL ADDRESS: AUTHORIZED REPRESENTATIVE POLICY EFF POLICY EXP (MM/DD/YYYY) (MM/DD/YYYY) DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) INSURER(S) AFFORDING COVERAGE FAX (A/C, No): LIMITS EACH OCCURRENCE $ $ $ GENERAL AGGREGATE DEDUCTIBLE RETRO DATE $ $ $ $ COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per accident) $ BODILY INJURY (Per person) PROPERTY DAMAGE (Per accident) $ $ $ $ $ $ EACH OCCURRENCE AGGREGATE PERSTATUTE OTH-ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ $ $ $ $ $ 03/17/2025 03/17/2025 NAIC # INSR LTR X ADDL S UBR IN SD WVD THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTSUPONTHE 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 suchendorsement(s). COVERAGES ACORD 25 (2016/03) CERTIFICATE HOLDER PROFESSIONAL LIABILITY CERTIFICATE NUMBER: CANCELLATION REVISION NUMBER: © 1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THISISTO CERTIFY THAT THE POLICIESOFINSURANCELISTED BELOW HAVE BEEN ISSUED TO THE INSUREDNAMED 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 SUCHPOLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIDCLAIMS. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. EACH INCIDENT AGGREGATE DEDUCTIBLE SEXUAL MISCONDUCT AGGREGATE RETRO DATE Professional Services Purchasing Group 1707 Post Oak Blvd #279 Houston TX 77056 United Indemnity Inc DATE (MM/DD/YYYY) 03/25/2025 X 03/17/2025 03/17/2025 03/17/2026 03/17/2026 1,000,000 3,000,000 1000 1,000,000 3,000,000 1000 1,000,000 3,000,000 Lifes Angels Transportation 201 W Main St, B29 Durham, North Carolina, 27701 UIA-366705-031725 UIA-366705-031725 Home Health Agencies Orange County 300 West Tryon Street P.O. Box 8181 Hillsborough, NC 27278 Docusign Envelope ID: BD30E40D-31E5-4EAD-B8AC-260FE4A9ABCC