2016-268-E Health - Maxim Physician Resources, LLC for temp nurse staff services

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DocuSign Envelope ID:6EB7A98E-7386-481D-BB68-D6A5BBAODDCB ACORN® DATE(MM/DD/YYYY) � CERTIFICATE OF LIABILITY INSURANCE 11/16/2015 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 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 Krista Dean NAME: Altus Partners, Inc A/c HONE Ext: (610)526-9130 FAX No: (610)526-2021 919 Conestoga Road ADDRESS:certificates @altuspartners.com Building Suite 311 PRODUCER 00000607 g r CUSTOMER ID#. Rosemont PA 19010 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A:Llo ds of London INSURER B ACE American Ins. Co. 22 667 Maxim Physician Resources, LLC INSURER C:Indemnity Ins. Co. of NA 43575 7227 Lee DeForest Drive INSURER D:Evans ton Insurance Co. 35378 Columbia MD 21046 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:15-16 MPR All Coverages 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 INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY PH1505206 (SIR) EACH OCCURRENCE $ 3,000,000 X 11/30/201511/30/2016 DAMAGE TO RENTED 100 000 COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ r A X CLAIMS-MADE 1:1 OCCUR MED EXP(Any one person) $ 2,000 X $3,000,000 SIR PERSONAL&ADV INJURY $ Include GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER Products PRODUCTS-COMP/OP AGG $ 3,000,000 X POLICY PRO LOC Exclusion $ JECT AUTOMOBILE LIABILITY H08865450 COMBINED SINGLE LIMIT $ 1,000,000 H08865462 (Owned) 11/30/201511/30/2016 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B X ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS X PROPERTY DAMAGE $ HIRED AUTOS (Per accident) X NON-OWNED AUTOS $ A X UMBRELLA LAB OCCUR PH1505206 11/30/2015 11/30/2016 EACH OCCURRENCE $ 7,000,000 EXCESS LIAB }{ CLAIMS-MADE AGGREGATE $ 7,000,000 DEDUCTIBLE $ X RETENTION $ 3,000,000 $ C WORKERS COMPENSATION C48591358 11/30/201511/30/2016 X WCSTATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE❑ E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 D Medical Professional 826023 11/30/201511/30/2016 Per claim $1,000,000 Liability Aggreate $3,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Certificate is issued as evidence of insurance per the policy terms, conditions, and exclusions. Coverage applies to for the days worked on behalf of MPR. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN For Information Purposes Only ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Krista Dean/KMD ' ACORD 25(2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025(200909) The ACORD name and logo are registered marks of ACORD