2012-153 Aging - Linda Cole, RN - Laserfiche WebLink

Browse Search

Print Date: 7/27/2012 HEALTHCARE PROVIDERS SERVICE CNAORGANIZATION PURCHASING GROUP ®n V O (Certificate of '1115m ance nurses service organization" OCCURENCE POLICY FORM Producer Branch Prefix Policy Number Policy Period 018098 970 HPG 0423623038 from 07/06/12 to 07/06/13 at 12:01 AM Standard Time Named Insured and Address: Program Administered by: Linda D Cole Nurses Service Organization 201 Davie Rd Apt A 159 E. County Line Road Carrboro, NC 27510-1670 Hatboro, PA 19040-1218 1-800-247-1500 www.nso.com Medical Specialty: Code: Insurance is provided by: Registered Nurse 80964 American Casualty Company of Reading, Pennsylvania Excludes Cosmetic Procedures 333 S.Wabash Avenue, Chicago, IL 60604 Professional Liability $ 500,000 each claim $2,500,000 aggregate Your professional liability limits shown above include the following: i • Good Samaritan Liability * Malplacement Liability Personal Injury Liability • Sexual Misconduct included in the PL limit shown above subject to$25,000 aggregate sublimit Coverage Extensions License Protection $25,000 per proceeding $25,000 aggregate Defendant Expense Benefit $ 1,000 per day limit $25,000 aggregate Deposition Representation $ 10,000 per deposition $10,000 aggregate Assault $25,000 per incident $25,000 aggregate Includes Workplace Violence Counseling Medical Payments $25,000 per person $100,000 aggregate First Aid $ 10,000 per incident $10,000 aggregate Damage to Property of Others $ 10,000 per Incident $10,000 aggregate Information Privacy(HIPAA)Fines and Penalties $25,000 per incident $25,000 aggregate Workplace Liability Workplace Liability Included in Professional Liability Limit shown above Fire&Water Legal Liability Included in the PL limit shown above subject to $150,000 aggregate sublimit Personal Liability $500,000 aggregate Total:$ 143.00 Base Premium $143.00 Premium reflects Self Employed , Part Time Policy Forms&Endorsements(Please see attached list for a general description of many common policy forms and endorsements.) G-121500-D GSL10546NC G-121503-C G-121501-C G-145184-A G-147292-A GSL15563 GSL15564 GSL15565 GSL17101 GSL13424 G-123846-C32 GSL3886 GSL3908 GSL19904 Keep this document in a safe place.It �� and proof of payment are your proof of .TI i coverage. There is no coverage in force un less the premium is paid in full.In order Chairman of the Board Secretary to activate your coverage,please remit premium in full by the effective date of i this Certificate of Insurance. Master Policy#188711433 G-141241-B(03/2010) Coverage Change Date: Endorsement Change Date: i