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DocuSign Envelope ID: FF596EF9-95C3-43F0-9E5B-F05288BBF843 ZOVIDERS SERVICE <br /> Cf#A ORGANIZATION PURCHASING GROUP mnso <br /> Certificate of Insurance <br /> nurses service ur�niza[iun-- <br /> OCCURENCE POLICY FORM Print Date: 9/25/2015 <br /> Producer Branch Prefix Policy Number Policy Period <br /> 018098 970 HPG 0127265153 from 10101115to 10101I16at 12:01 AM Standard Time <br /> Named Insured and Address: Program Administered by: <br /> Durham Technical Community College Nurses Service Organization <br /> 1637 E Lawson St 159 E. County Line Road <br /> Durham, NC 27703-5023 Hatboro, PA 19040-1218 <br /> 1-800-986-4627 <br /> www.nso.com <br /> Medical Specialty: Code: Insurance is provided by: <br /> School Blanket-Healthcare Provider Students 80998 American Casualty Company of Reading, Pennsylvania <br /> 333 S. Wabash Avenue, Chicago, IL 60604 <br /> Professional Liability $2,000,000 each claim $5,000,000 aggregate <br /> Your professional liability limits shown above include the following: <br /> Personal Injury Liability <br /> Coverage Extensions <br /> Grievance Proceedings $ 1,000 per proceeding $ 10,000 aggregate <br /> Defendant Expense Benefit $ 10,000 aggregate <br /> Deposition Representation $ 1,000 per deposition $ 5,000 aggregate <br /> Assault $ 1,000 per incident $25,000 aggregate <br /> Medical Payments $ 2,000 per person $ 100,000 aggregate <br /> First Aid S 500 per incident $25,000 aggregate <br /> Damage to Property of Others $ 250 per incident $ 10,000 aggregate <br /> Total: $22,162.00 <br /> Base Premium $22,162.00 <br /> Policy Forms& Endorsements(Please see attached list for a general description of many common policy forms and <br /> endorsements.) <br /> G-144918-A CNA79561 G-144931-A32 G-144932-A32 G-144922-A <br /> Keep this document in a safe place.It <br /> and proof of payment are your proof <br /> coverage, There is no coverage in force <br /> unless the premium is paid in full In 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-B(03/2010) Coverage Change Date: Endorsement Change Date: <br />