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DocuSign Envelope ID:84D563A0-30F8-4571-947C-73CC853AB58C
<br /> HEALTHCARE PROVIDERS SERVICE
<br /> ORGANIZATION PURCHASING:GROUP,
<br /> CNA cattficate o�f 3jiu mu:aure mnsy
<br /> OCCURRENCE POLICY FORM:
<br /> PRODI.JgER BLANCH' 11 �1 POLICY NUM13ER Pq-I Licy P
<br /> 0180989147 H�PG
<br /> 18( 3 1 From 04/22/15 toy 0412.2A6 at 122 AM Stand and Time
<br /> Named Insured ............ REgg_ra-kqiLqnisLcLrF-d by.
<br /> Jennifer Sugg NUrses'Service Organizzition
<br /> 159 E,County Une Road
<br /> PC),Box 272 Hatboro,P'A 19040-12'18
<br /> Byrun,NC 27228-0272' 1-800-247•1500
<br /> www.nsa,corni
<br /> Medical Code i !
<br /> Insurance e i
<br /> Registered Nun 80964 "—' _1prqvid
<br /> Arnerican Casuatty Company of Reading
<br /> Penn'sylvanta
<br /> 333 South Wabash Avenue Chicago,11111nois 60604
<br /> .EcqJ-quiqn,p I LJ.ab $1,000,000 each h clahn $6,000,000,aggregate
<br /> Y b,nb ki#a^p ITJIi shwm wow 4)dude Vie lci0LiMng:
<br /> •Good Sarnaritan,1,,iabfljly •Malplacernent Liability Personal Injury Ltabilfty
<br /> •Sexual MiFconduct Included tn the PL Limilshowniabove to$25,000 aggregate subkrrflt
<br /> goyerqge Extensions
<br /> ...................pro..............................................
<br /> Licenv�Protection $ 25,000 per ceeding $ 25,0001 aggragate
<br /> Defendant Expense Benefit $ 1,000 per(Jay Iiryi4t $ 25,000 aggregate
<br /> [)eposkion Represenu0on $ 10.0010 per daposillon $ 10,000 aggregate
<br /> Asf ault $, 25,0100 per incident $ 25,000 aggregate
<br /> lndudns WaMpkice Vicienco CoonsvAng
<br /> 1vle6caG Paymer its $ 25,000 per person $ 100,000 aggreg-ate
<br /> First Aid $ 10,000 per Imlderrf $ 10,000 aggregite
<br /> Darnage,to Property of Others $ 10,(Y00 per incident $ 10,000 aggregalo
<br /> Intorinaflon Pdvacy(HPAA)Fines&Penalties $ 25,000 per lmdent $ 25,000 aggregate
<br /> )Y—orKeLa .......... ....................
<br /> Workplace.Liability IriclUded m l role. sional Liability I irrml shown above
<br /> Rue and Water LeWil I'JaNfity Included pn the Pl-fimft above subject to$150,000 ieMregale subfirnit
<br /> Personal UablRy $1,000,000 aggragato
<br /> Total-. '53.00
<br /> ...........................................................................
<br /> Prernkm r0lects ernployed,fulMtrne rate with recent graduate dizoount,
<br /> Policy Forms&Endorstryients fi�kose p,,5t fa'u
<br /> G..121500-1) G-1215011-C G-121503-C 0: 145184-A G-147292A GSL3886 GSL3908 3`31.13424 Gsl,15.563 GSt-1151,64
<br /> GSL15565 GSL17101 CNA801052 CNA80051 G-123843--= GSL10546NC
<br /> i A
<br /> I"V
<br /> ChaIrman of the Board Secretary
<br /> Keep this Certificate of jnsurance Ini a safe pNace. This Certfficato of Insurance and proof of payment are your proof ofooverage.
<br /> There is no ooverage i"force unless the premiunit Is paid in fulli.In order to activate your coverage,please remit prerniturn,In fuil by
<br /> the effective date of Vii s Certificate of Insurance,
<br /> it
<br /> Foun 4 G!..141241-8(3/2.D 10), Master Poflcy„188711433
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