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. , <br /> HEALTHCARE PROVIDERS SERVICE <br /> ORGANIZATION PURCHASING GROUP <br /> NA. Certificate of htt‘ttrante tins° <br /> nurses service organizationOCCURRENCE POLICY FORM <br /> PRODUCER BRANCH PREFIX POLICY NUMBER Policy Period: <br /> ' 018098 '97G ;','' HPG 0003508294-8 From 09/08/11 to 09/08/12 at 12:01 AM Standard Time <br /> Named Insured Program Administered by: <br /> Nurses Service Organization <br /> Linda K.Textoris 159 East County Line Road <br /> 750 Weaver Dairy Rd. Apt. 204 Hatboro, PA 19040-1218 <br /> Chapel Hill, NC 27514-1466 1-800-247-1500 <br /> www.nso.com <br /> Medical Specialty Code Insurance is provided by: <br /> Registered Nurse 80964 American Casualty Company of Reading, Pennsylvania <br /> 3 South WabaSFAvenue Chicago,Illinois 60604- <br /> Professional Liability $1,000,000 each claim $6,000,000 aggregate <br /> Your professional liability limits shown above include the following: <br /> •Good Samaritan Liability • Malplacement Liability • Personal Injury Liability <br /> • Sexual Misconduct included in the PL Limit shown above subject to $25,000 aggregate sublimit <br /> Coverage Extensions <br /> License Protection $25,000 per proceeding $25,000 aggregate <br /> Defendant Expense Benefit $1,000 per day limit $25,000 aggregate <br /> Deposition Representation $10,000 per deposition $10,000 aggregate <br /> Assault $25,000 per incident $25,000 aggregate <br /> Includes Workplace Violence Counseling <br /> Medical Payments $25,000 per person $100,000 aggregate <br /> First Aid $10,000 per incident $10,000 aggregate <br /> Damage of Property of Others $10,000 per incident $10,000 aggregate <br /> Information Privacy(HIPAA) Fines&Penalties $25,000 per incident $25,000 aggregate <br /> Workplace Liability - <br /> Workplace Liability Included in Professional Liability Limit shown above <br /> Fire and Water Legal Liability Included in the PL limit above subject to$150,000 aggregate sub limit <br /> Personal Liability $1,000,000 aggregate <br /> Total: $106.00 <br /> Premium reflects employed, full-time rate. <br /> Policy Forms& Endorsements(Please see attached list for a general description of the policy forms/endorsements that may or may not apply to this policy) <br /> G-121500-D G-121501-C G-121503-C G-145184-A G-147292-A GSL3886 GSL3908 GSL13424 GSL15563 <br /> GSL15564 GSL15565 GSL17101 G-123846-C32 GSL10546NC <br /> 440304+44 cc. 14644*44LCI, cavAfuill ilAi Chairman of of the Board Secretary <br /> Keep this Certificate of Insurance in a safe place. This Certificate of Insurance and proof of payment are your proof of coverage. <br /> There is no coverage in force unless the premium is paid in full. In order to activate your coverage, please remit premium in full by <br /> the effective date of this Certificate of Insurance. <br /> I G-141241-13 NM113) Nlv-a%\ts?0S\ .'Vtolii MtPo'L 1 <br /> i <br /> 402 XX 0001755-R 110630 N10910 R1K7MM 11181 <br /> d111111111.111111.11111.11111.11111111.11111111111111111111111111111111111111111111111 <br />