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HEALTHCARE PROVIDERS SERVICE <br />ORGANIZATION PURCHASING GROUP <br />018098 970 HPG 0273935164-8 From 07/27/18 to 07/27/19 at 12:01 AM Standard Time <br />Charron F Andrews <br />108 Cottonwood Ct <br />Chapel Hill, NC 27514-1629 <br />Healthcare Providers Service Organization <br />1100 Virginia Drive, Suite 250 <br />Fort Washington, PA 19034-3278 <br />1-800-982-9491 <br />www.hpso.com/renew <br />American Casualty Company of Reading, Pennsylvania <br />333 South Wabash Avenue Chicago, Illinois 60604 <br />$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 />License Protection <br />Defendant Expense Benefit <br />Deposition Representation <br />Assault <br /> Includes Workplace Violence Counseling <br />Medical Payments <br />First Aid <br />Damage to Property of Others <br />Information Privacy (HIPAA) Fines & Penalties <br />Media Expense <br />Workplace Liability Included in Professional Liability Limit shown above <br />Fire and Water Legal Liability Included in the PL limit above subject to $150,000 aggregate sublimit <br />Personal Liability $1,000,000 aggregate <br />Total: $157.00 <br />(Please see attached list for a general description of many common policy forms and endorsements.) <br />G-121500-D G-121501-C G-121503-C CNA82011 G-145184-A G-147292-A CNA81753 CNA81758 GSL13424 GSL15563 <br />GSL15564 GSL15565 GSL17101 CNA80052 CNA80051 G-123846-C32 GSL10546NC CNA89026 CNA89026 CNA89027 <br />Form #: G-141241-B (3/2010) Master Policy: 188711433 <br />Premium reflects employed, full-time rate. <br />HPSO-405-R-PHY-H1 20180709-005 <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />25,000 <br />1,000 <br />10,000 <br />25,000 <br />25,000 <br />10,000 <br />10,000 <br />25,000 <br />25,000 <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />per proceeding <br />per day limit <br />per deposition <br />per incident <br />per person <br />per incident <br />per incident <br />per incident <br />per incident <br />25,000 <br />25,000 <br />10,000 <br />25,000 <br />100,000 <br />10,000 <br />10,000 <br />25,000 <br />25,000 <br />aggregate <br />aggregate <br />aggregate <br />aggregate <br />aggregate <br />aggregate <br />aggregate <br />aggregate <br />aggregate <br />Physical Therapist <br />Workplace Liability <br />80995 <br />Print Date: 07/09/18 <br />DocuSign Envelope ID: 8E107476-783D-40A7-92C4-E8E03CD0E84F