Orange County NC Website
Browse       Search
DocuSign Envelope ID:61C58E40-1A9C-468F-A21D-D525A55FD8DB <br /> HEALTHCARE PROVIDERS SERVICE <br /> CNAORGANIZATION PURCHASING GROUP <br /> Certificate of 31115111:mice alificarc Providcn'ker,,ec Or-pm:ohm' <br /> OCCURRENCE POLICY FORM Print Date: 6/17/2016 <br /> Producer Branch Prefix Policy Number Policy Period <br /> 018098 970 HPG from 06/16/16 to 06/16/17 at 12:01 AM Standard Time <br /> Named Insured and Address: Program Administered by: <br /> Return 2 Recess, LLC Healthcare Providers Service Organization <br /> Po Box 106 159 E. County Line Road <br /> Carrboro, NC 27510-0106 Hatboro, PA 19040-1218 <br /> 1-888-288-3534 <br /> www.hpso.com <br /> Medical Specialty: Code: Insurance is provided by: <br /> Health Educator Firm 00000 American Casualty Company of Reading, Pennsylvania <br /> 333 S. Wabash Avenue, Chicago, IL 60604 <br /> Excludes Cosmetic Procedures <br /> Professional Liability $1,000,000 each claim $ 3,000,000 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 /> Policy Forms& Endorsements(Please see attached list for a general description of many common policy forms and <br /> endorsements.) <br /> G-121500-D GSL10546NC G-121501-C G-145184-A G-147292-A GSL15563 <br /> GSL15564 GSL15565 GSL17101 GSL13424 GSL13425 CNA80052 <br /> G-123846-C32 CNA81753 CNA81758 CNA82011 G-121504-C G-123827-B <br /> CNA79575 GSL-6720 GSL-6721 <br /> Keep this document in a safe place.It <br /> 4.44W414 ItstiOAAACI, C61)444/1A 'll'd\-■ and proof of payment are your proof of <br /> coverage There is no coverage in force <br /> unless the premium is paid in full.ln order <br /> to activate your coverage, please remit <br /> Chairman of the Board Secretary premium in full by the effective date of <br /> this Certificate of Insurance. <br /> Master Policy# 188711433 <br /> G-141241-6(03/2010) Coverage Change Date: Endorsement Change Date: <br />