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DocuSign Envelope ID:3E3FB60E-F222-4DA0-BB07-8BE54CB4F178 <br /> HEALTHCARE PROVIDERS SERVICE <br /> ORGANIZATION PURCHASING GROUP <br /> Certificate of hiorante i <br /> '�...',. nso <br /> nurses service❑manizition <br /> OCCURRENCE POLICY FORM Print Date: 01/16/19 <br /> PRODUCER BRANCH PREFIX POLICY NUMBER Policy Period: _. <br /> 018098 970 HPG 031 21 1 5639-8 From 03/27/19 to 03/27/20 at 12:01 AM Standard Time <br /> Named insured Program Administered by: <br /> Nurses Service Organization <br /> Janice Galloway 1100 Virginia Drive, Suite 250 <br /> 6615 Glen Forrest Dr Fort Washington, PA 19034-3278 <br /> Chapel Hill, NC 27517-8631 1-800-247-1500 <br /> www.nsc.com/renew <br /> Medical Specialty Code Insurance is provided by-- <br /> Registered Nurse 80964 American Casualty Company of Reading, Pennsylvania <br /> 333 South Wabash Avenue Chicago, Illinois 60604 <br /> Professional Liability $1,000,000 each claim $6,000,000 aggregate <br /> Your professional liability limits shown above include the following' <br /> ■Good Samaritan Llability ■ Malplacement Liability • Personal Injury Liability <br /> ■Sexual Misconduct included in the PL Limit shown above subject to$25,000 aggregate sublimit <br /> Coverage Extensions <br /> License Protection $ 25,000 per proceeding $ 25,000 aggregate <br /> Defendant Expense Benefit $ 1,000 per day limit $ 25,000 aggregate <br /> Deposition Representation $ 10,000 per deposition $ 10,000 aggregate <br /> Assault $ 25,000 per incident $ 25,000 aggregate <br /> includes Workplace Violence Counseling <br /> Medical Payments $ 25,000 per person $ 100,000 aggregate <br /> First Aid $ 10,000 per incident $ 10,000 aggregate <br /> Damage to Property of Others $ 10,000 per incident $ 10,000 aggregate <br /> Information Privacy(i•iIPAR) Fines&Penalties $ 25,000 per incident $ 25,000 aggregate <br /> $ 25,000 per in5ident $ 25,000 aggregate <br /> Media Expense <br /> Workplace Liability <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:$10&00 <br /> Premium reflects employed, full-time rate. <br /> PolicV Farms & Endorsements Please see attached list fora general.description of many common Colio forms and endorsements. <br /> G-121500-D G-121501-C G-121503-C GNA82011 G-145184-A G-147292-A CNAB1753 CNA81758 GSL13424 GSL15563 <br /> GSL15564 GSL15565 GSL17101 CNA80052 CNA80051 G-123846-C32 GSL10546NO CNA89026 CNA89027 <br /> Chairman of the Board Secretary <br /> Keep this Certificate of Insurance in a safe place. This Certificate of insurance and proof of payment are your proof of coverage. <br /> There is no coverage in force unless the premium is paid in full. In order to activate your coverage, please remit premium in full by <br /> the effective date of this Certificate of Insurance. <br /> Farm #: G-141241-B(3/2010) Master Policy: 188711433 <br />