Certificates of Insurance 74/9/2021
E(MM/DDYYY)
A�" CERTIFICATE OF LIABILITY INSURANCE /Y
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: Glenn LeBlanc
ArthurJ. Gallagher Risk Management Services, Inc. HON Ext: 337-769-0860 Fvc,No:337-429-2234
235 Highlandia Drive, Suite 200 (AMAIL
Baton Rouge LA 70810 ADDRESS: Glenn.LeBlanc@lhcgroup.com
INSURER(S)AFFORDING COVERAGE NAIC#
INSURERA: Illinois Union Insurance Company 27960
INSURED LHCGROU-03 INSURERB:ACE American Insurance Company 22667
LHC Group, Inc.
901 Hugh Wallis Rd-S INsuRERc: Indemnity Insurance Company of N A 43575
Lafayette LA 70508 INSURER D
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:709913182 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 MM/DD
A X COMMERCIAL GENERAL LIABILITY Y HPLG27171928007 10/1/2020 10/1/2021 EACH OCCURRENCE $1,000,000
� OCCUR DAMAGE TO
CLAIMS-MADE
PREMISES(Ea occurrence)
ccurrence) $300,000
Approved Risk Managerrent MED EXP(Any one person) $
PERSONAL&ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000
X POLICY❑ PRO ❑ LOC 4-9-2021
JECT PRODUCTS-COMP/OP AGG $3,000,000
OTHER: $
B AUTOMOBILE LIABILITY Y ISAH25305917 10/1/2020 10/1/2021 COMBINED SINGLE LIMIT $1,000,000
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
A UMBRELLA LAB OCCUR XHLG2717193AO07 10/1/2020 10/1/2021 EACH OCCURRENCE $10,000,000
X EXCESS LAB CLAIMS-MADE AGGREGATE $10,000,000
DED RETENTION$ $
G WORKERS COMPENSATION WLRC67459362 10/1/2020 10/1/2021 X PER OTH-
AND EMPLOYERS'LIABILITY Y/N STATUTE ER
ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000
OFFICE R/M EMBER 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 Medical Professional Liability HPLG27171928007 10/1/2020 10/1/2021 Each Incident $1,000,000
Claims Made Aggregate $3,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
Certificate holder is an additional insured with regards to General Liability and Auto Liability if required by written contract.
Florida Location:
Key West PD, LLC d/b/a Island Private Care(Cudjoe Key, FL)
Key West HHA, LLC d/b/a Island Home Care(Key West, FL)
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.
Monroe County BOCC
1100 Simonton Street AUTHORIZED REPRESENTATIVE
Key West FL 33040
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