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DocuSign Envelope ID: FF596EF9-95C3-43F0-9E5B-F05288BBF843
<br /> Compensation and Other disclosure Information
<br /> Healthcare Providers Service Organization(HPSO)a registered trade name of Affinity Insurance Services,Inc.,exclusively offers the
<br /> HPSO Program as an agent of CNA and provides services that may include the following-program marketing,underwriting,policy
<br /> management,billing,risk management and client services on its behalf,
<br /> Affinity Insurance Services Inc.is an insurance producer licensed in your state.Insurance producers are authorized by their license to
<br /> confer with insurance purchasers about the benefits,terms and conditions of insurance contracts;to offer advice concerning the
<br /> substantive benefits of particular insurance contracts;to sell insurance;and to obtain insurance for purchasers.The role of the producer
<br /> in any particular transaction involves one or more of time activities.Compensation will be paid to the producer,based on the insurance
<br /> contract the producer sells.Depending on the insurer(s)and insurance contract(s)the purchaser selects,compensation will be paid by
<br /> the insurer(s)selling the insurance contract or by another third party.Such compensation may vary depending on a number of factors,
<br /> including the insurance contract(s)and the insure(s)the purchaser selects.In addition,Affinity may charge a fee for administrative
<br /> services.Your signature on your application,quote form,check,and/or other authorization for payment of your premium,will be
<br /> deemed to signify your consent to and acceptance of the terms and conditions including the compensation,as disclosed above,that is to
<br /> be received by Aon.The insurance purchaser may obtain information about compensation expected to be received by the producer
<br /> based in whole or in part on the sale of insurance to the purchaser,and compensation expected to be received based in whole or in part
<br /> on any alternative quotes presented to the purchaser by the producer,by contacting member services at 1-800-9864627.
<br /> In addition,premiums paid by Clients to Affinity for remittance to insurers,Client refunds and claim payments paid to Affinity by
<br /> insurance companies for remittance to Clients are deposited into fiduciary accounts in accordance with applicable insurance laws until
<br /> they are due to be paid to the insurance company or Client. Subject to such laws and the applicable insurance company's consent,
<br /> where required,Affinity will retain the interest or investment income earned while such funds are on deposit in such accounts.
<br /> In placing,renewing,consulting on or servicing your insurance coverages Affinity and its affiliates may participate in contingent
<br /> commission arrangements with insurance companies that provide for additional contingent compensation,if,for example,certain
<br /> underwriting,profitability,volume or retention goals are achieved.Such goals are typically based on the total amount of certain
<br /> insurance coverages placed by Aon with the insurance company or the overall performance of the policies placed with that insurance
<br /> company,not on an individual policy basis.As a result,Aon may be considered to have an incentive to place your insurance coverages
<br /> with a particular insurance company.
<br /> Our liability to you,in total, for the duration of our business relationship for any and all damages,costs,and expenses(including but
<br /> not limited to attorneys'fees),whether based on contract,tort(including negligence),or otherwise,in connection with or related to our
<br /> services(including a failure to provide a service)that we provide in total shall be limited to the lesser of S6,000,000 or the singular
<br /> annual limit of the policy of insurance procured by us on your behalf from which your damages arise.
<br /> This liability limitation applies to you,our client,and extends to our client's parent(s),affiliates,subsidiaries,and their respective
<br /> directors,officers,employees and agents(each a"Client Group Member"of the"Client Group' wherever located that seek to assert
<br /> claims against ARS,and its parent(sX affiliates,subsidiaries and their respective directors,officers,employees and agents(each an
<br /> "Aon Group Membee'of the"Aon Group"). Nothing in this liability limitation section implies that any Aon Group Member owes or
<br /> accepts any duty or responsibility to any Client Group Member.
<br /> If you or any of your Group Members asserts any claims or makes any demands against us or any Aon Group Member for a total
<br /> amount in excess of this liability limitation,then you agree to indemnify ARS for any and all liabilities,costs,damages and expenses,
<br /> including attorneys'fees,incurred by AILS or any Aon Group Member that exceeds this liability limitation.
<br /> Aon Corporation,our ultimate parent company,and its affiliates have from time to time sponsored and invested in insurance and
<br /> reinsurance companies. While we generally undertake such activities with a view to creating an orderly flow of capacity for our clients,
<br /> we also seek an appropriate return on our investment. These investments,for which Aon is generally at-risk for potential price loss,
<br /> typically are small and range from fixed-income to common stock transactions. In such case,the gains or losses we make through your
<br /> investments could potentially be linked,in part,to the results of treaties or policies transacted with you. Please visit the Aon website at
<br /> httn://www non.com/market relationshiM for a current listing of insurance and reinsurance carriers in which Aon Corporate and its
<br /> affiliates hold any ownership interest.
<br /> FATCA Notice:Please go to www.aon.com/FATCA to obtain the appropriate W-9.
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