2017-528-E HR - Envision Pharmaceutical Services, LLC for pharmacy benefits

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DocuSign Envelope ID:E8C538EF-9595-4E36-A4C9-2CA66C7BE34A ® DATE(MM/DD/YYYY) A CERTIFICATE OF LIABILITY INSURANCE 06/30/2017 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 have ADDITIONAL INSURED provisions or 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 t certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT a NAME: Aon Risk Services Northeast, Inc. PHONE FAX New York NY Office (A/C.No.Ext): (866) 283-7122 (A/C.No.): (800) 363-0105 L 199 water Street E-MAIL p New York NY 10038-3551 USA ADDRESS: _ INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: National Union Fire Ins Co of Pittsburgh 19445 Envi si on Pharmaceuti cal Holdings, LLC INSURER B: 2181 E. Aurora Road, Suite 201 Twinsburg OH 44087 USA INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570068176206 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. Limits shown are as requested INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DD/YYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) MED EXP(Any one person) PERSONAL&ADV INJURY �O 0 N GEN'LAGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE POLICY PE6 LOC PRODUCTS-COMP/OPAGG m • o OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) , ANY AUTO BODILY INJURY(Per person) O Z OWNED SCHEDULED BODILY INJURY(Per accident) AUTOS ONLY _ AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE ONLY AUTOS ONLY (Per accident) • 4) d UMBRELLA LIAB OCCUR EACH OCCURRENCE U EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION WORKERS Y C COMPENSATION Y/ T N AND I PER STATUTE I I0TH- ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT -_ A Cyber Liability 013081143 03/17/2017 03/17/2018 Limit of Liability 510,000,000 SIR applies per policy terms & conditions SIR $2,500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if mom space is required) see attached for all policies CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Envi si on Pharmaceuti cal Services, LLC AUTHORIZED REPRESENTATIVE 2181 E. Aurora Road .�^ suite 201 Twinsburg ON 44087 USA i�� este+ioeee1 ,�`/,'� tom. cf'✓�Ge� e J - ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD