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DocuSign Envelope ID: EAE3745D -23C6- 4352- A3D7- 9903DCB5D084 <br />PATE (MMIDDiYYYYJ <br />© CERTIFICATE OF LIABILITY INSURANCE 41212018 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer riiahts to the certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />The Graham Company <br />The Graham Building <br />1 Penn Square West <br />Philadelphia PA 19102- <br />INSURED SELEMED -01 -- - -- <br />Select Physical Therapy Holdings, Inc. <br />C/o Select Medical Corporation <br />4716 Old Gettysburg Road <br />Mechanicsburg PA 17055 <br />INSURERI§) AFFORDING COVERAGF <br />NAIC ff <br />=RA: Llbe Mutual Fire Ins. Co. <br />_23035 <br />-- 42404 <br />=R A.- Libe Insurance Carpa_rafion <br />MR C.- Columbia Casualty Company <br />-RD: American Guarantee & Liability . -- _ - -- <br />31127 <br />25247 <br />:RE:. Allied World Assurance_Cumpany,_Ltd. {ROMICILEt? <br />COVERAGES CERTIFICATE NUMBER: 1170875259 REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID-CLAIMS. <br />[NSR <br />LTR <br />TYPEaFiNSURANCE <br />111=SUBR <br />POLICYNUMBER <br />MMIIDIYYYY <br />MMi� DIYYYY <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />EACI -I OCCURRENCE <br />$ <br />CLAIMS -MADE n OCCUR <br />PREMISES FaFoowrrenee <br />$ <br />MEO FXP (Any one person) <br />$ <br />PERSONAL $ RDV INJURY <br />$ <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$ <br />POLICY 1:1 JECT PRO- LOG <br />PRODUCTS - COMPIOPAGO <br />$ <br />$ <br />OTHER: <br />A <br />AUTOMOBILE LIABILITY <br />-1 <br />AS2- 631- 5DM47•038 <br />4/112018 <br />4/7/209 <br />Co-'al NF DSINGI.F.L.IMIT <br />Ea acddenl <br />$ 000 0 <br />BODILY INJURY (Per person) <br />$ <br />X ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY (Per accident) <br />$ <br />PROPFRTYDAMAGE <br />Per acclden <br />$ <br />HIRED NON-OWNF.O <br />AUTOS ONLY AUTOS ONLY <br />F <br />UMBRELLA LIAB X OCCUR <br />0001445016 <br />1213112017 <br />12131/2018 <br />EACH OCCURRENCE <br />$25,006,000 <br />X <br />AGGREGATE <br />$ 25,000,000 <br />EXCESS LIAB CLAIMS -MADE <br />BED I I RETENTION $ <br />$ <br />- <br />B <br />0 <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />WA7 -63D- 599047418 <br />WC7 -630- 502047 -028 <br />41112018 <br />41112018 <br />41112019 <br />41112p19 <br />X STATUTE FOR TH <br />ANYPROPRIETORIPARTNERIEXECUTIVE <br />E.L. EACH ACCIDENT <br />$1,000,000 <br />OFF ICE RfMEM 8ER EXCLUDED? ❑ <br />N 1 A <br />(Mandatory In NH) <br />E.L. DISEASE - EA EMPLOYEE <br />$1,000,000 <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS belcw <br />E.L. DISEASE - POLICY LIMn <br />$1,000,000 <br />C <br />Excess General/Professlonal Llab. <br />HMU 20662484s6 -i4 <br />M112017 <br />12I311201S <br />See Helovi <br />D <br />Prapefty <br />ZMM91783712 <br />42!3112017 <br />1213112018 <br />See Beiew <br />DFSCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 10t, Additional Remarks Schedule, may be attached it more space is required) <br />EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE (CGL) -- $10M Each Occurrencel$10M Aggregate Limit EXCESS of $2M Self- Insured Retention; <br />EXCESS PROFESSIONAL LIABILITY COVERAGE (PL) - $7M Each Clalml$7M Aggregate Limit Excess of $5M Self- Insured Retention; Both Coverages are <br />subject to a $10M Policy Aggregate Limit. <br />PROPERTY COVERAGE: $5,000,000 Limit for Unnamed /Unscheduled Locations; Specified Limits for Scheduled Locations. <br />CERTIFICATE HOLDER CANCELLATION <br />Select (Physical Therapy Holdings, Inc. <br />dba Select Physical Therapy <br />c/o Select Medical Corporation <br />4716 Old Gettysburg Road <br />Mechanicsburg PA 17055 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />-i <br />0 9988 -2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2096103) The ACORD name and logo are registered marks of ACORD <br />