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CERTIFICATE OF LIABILITY INSURANCE
A�" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/D D/YYYY) 09/19/2023 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 Lori Mullins NAME: Solace Insurance PHCONEo (727)585-1174 FAX NExt): C,No (727)559-0301 A/ A/ 10801 Starkey Rd Ste 104,109 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Seminole FL 33777 INSURERA: Philadelphia Insurance Companies 18058 INSURED INSURER B: Travelers Insurance 31194 Hope Villages ofAmerica Inc INSURER C: Beazley Insurance 37540 503 South Martin Luther King Jr.Avenue INSURER D: Great American Ins Co 16691 INSURER E: Business First Ins Co 11697 Clearwater FL 33756 INSURER F: COVERAGES CERTIFICATE NUMBER: 2023 GL,BA,PL,UM,D&O REVISION NUMBER: THIS IS TO CERTIFYTHAT 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 MAYBE 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 POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100 000 CLAIMS-MADE X OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ 5,000 A PHPK2525846 03/01/2023 03/01/2024 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATELIMITAPPLIESPER: GENERAL AGGREGATE $ 3,000,000 PX POLICY ❑PECT ❑LOC PRODUCTS-COMP/OPAGG $ 3,000,00(1 OTHER: Employee Benefits $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANYAUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED PHPK2525846 03/01/2023 03/01/2024 BOD I LY I NJ U RY(Per accident) $ AUTOS ONLY AUTOS X HIRED �/ NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY /� AUTOS ONLY Per accident Medical payments $ 5,000 X UMBRELLA LAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE PHUB853978 03/01/2023 03/01/2024 AGGREGATE $ DED I X1 RETENTION $ 10,000 $ WORKERS COMPENSATION ER/� STATUTE EORH AND EMPLOYERS'LIABILITY Y/N 1'000'000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ E OFFICER/MEMBER EXCLUDED? N/A 521-21819 06/01/2023 06/01/2024 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Directors&Officers Each Occurrence $2,000,000 D Employment Practices Liability EPPE910984 03/01/2023 03/01/2024 Aggregate $2,000,000 Retention $10,000/$25,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CRIME-is via Insurer B above-policy#107054158,Max Limit$500,000 3/1/2022-2025(see policy for full detail) CYBER-is via Insured C above-policy number W2662D210501,Max Limit$1,000,000 3/1/2023-2024(see policy for full detail) Professional Liability subject to a sublimit of$1,000,000 Umbrella policy extends over General Liability,Commercial Auto Liability,Professional Liability,Employee Benefits Liability and Abuse and Molestation CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN "For Informational Purposes ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ADDITIONAL COVERAGES Ref# Description Coverage Code Form No. Edition Date SEX/PHYS ABUSE OR MOLESTATION Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 1,000,000 3,000,000 Ref# Description Coverage Code Form No. Edition Date Professional Liability PROF Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 1,000,000 3,000,000 Ref# Description Coverage Code Form No. Edition Date PIP-Basic PIP Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 10,000 Ref# Description Coverage Code Form No. Edition Date WS WS Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium -$480.36 Ref# Description Coverage Code Form No. Edition Date Drug Free Credit DRUGF Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium -$1,176.89 Ref# Description Coverage Code Form No. Edition Date Premium discount PDIS Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium -$1,124.84 Ref# Description Coverage Code Form No. Edition Date Expense constant EXCNT Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $160.00 Ref# Description Coverage Code Form No. Edition Date Increased employer's liability INEL Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 1,000,000 $331.61 Ref# Description Coverage Code Form No. Edition Date Experience Mod Factor 1 EXP01 Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 1,000,000 Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium rOFADTLCV Copyright 2001,AMS Services,Inc. AGENCY CUSTOMER ID: 00016975 LOC#: ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED Solace Insurance Hope Villages ofAmerica Inc POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Umbrella policy extends over General Liability,Commercial Auto Liability,Professional Liability,Employee Benefits Liability and Abuse and Molestation Liability ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD