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DocuSign Envelope ID:00D05599-14C3-451 E-84B4-EDC8CADBDAFD <br /> ACCIIJ?" CERTIFICATE OF LIABILITY INSURANCE PAT /28/2DIYYYY] <br /> 3 <br /> 1z81zo1s <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(tes)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 rights to the certificate holder In lieu of such endorsement($). <br /> PRODUCER CNAMIACT 5electMed Unit <br /> The Graham Company PHONE FAx <br /> The Graham Building a MAIL Ext):215-567-6300 Arc Nos 215-405-2711 <br /> 1 Penn Square West ADDRESS: SELECTME❑ UNIT@grahamco.com <br /> Philadelphia PA 19102- INSURERS AFFORDING COVERAGE NAIC# <br /> INSURER A.Columbia Casualty Company 31127 <br /> INSURED SELEMED-01 INSURER a:American Guarantee&Liability Ins.Co. 26247 <br /> SELECT PHYSICAL THERAPY HOLDINGS, INC. INSURERC:Allied World Assurance Company,Ltd. DOMICILED <br /> c/o Select Medical Corporation <br /> 4716 Old Gettysburg Road INSURER D:Liberty Mutual Fire ins.Co. 23035 <br /> Mechanicsburg PA 17055 INSURER E:Li be rty Insurance Cor oration 42404 <br /> INSURER F: <br /> COVERAGES CERTIFICATE N UMBER:788083230 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 /> INSR ADD SUBR POLICY EFF POLICY EXP LIMITS <br /> LTR TYPE OF INSURANCE JNSD I WVD POLICYNUMBER 4MMIDDlYYYY M <br /> M1ODrYYY <br /> COM M ERCIAL GEN E RA L LIABILITY EACH OCCURRENCE S <br /> DAMAUE TO RENTED <br /> CLAIMS-MADE 7OCCUR PREMISES Ea occurrence $ <br /> MEd EXP Any oneperson) $ <br /> PERSONAL&ADV INJURY $ <br /> GEN'L AG G REGATE LI MIT APPLIES PER: GENERAL AGGREGATE $ <br /> POLICY PRO JECT LOC PRODUCTS-COMPIOP AGG $ <br /> OTHER: $ <br /> D AUTOMOBILE LIABILITY A82-631-509047-039 4/1/2019 41112020 COMBINED SINGLE LIMIT $2,000,ODD <br /> Ea accident <br /> X ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY ALTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> C UMBRELLA LIAR X OCCUR C001445-017 12J3112018 12/31/2019 EACH OCCURRENCE $25,000,000 <br /> X EXCESS LIAR CLAIMS-MADE AGGREGATE $25,000.00D <br /> DED I RETENTIONS $ <br /> E WORKERS COMP ENSATiON WA7-630-509047-019 4/1/2019 4/1/2020 X STEAARTUTE ERN- <br /> E AND EMPLOYERS•L"ILITY Yr N WC5-632-509047.029 41112019 4/1/2020 <br /> ANY PROPRIETORIPARTNERIEXECUTIVE ❑ N rA E,L,EACH ACCIDENT $1,000,000 <br /> OFF ICERIMEMB E R EXC LU DED7 <br /> (Mandatory in NH) L.DISEASE-EA EMPLOYEE $1,DDD,OOD <br /> if s,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 <br /> A Excess General+Pra[esslonal Llab, HMU2066248465-15 12/3112018 12J3112019 see Below <br /> B Property ZMD5917837-13 12/3112018 12/31/2019 See Below <br /> IT <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If 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 Claiml$71V Aggregate Limit Excess of$5M Self-Insured Retention;Both Coverages are <br /> subject to a$10M Policy Aggregate Limit. <br /> PROPERTY COVERAGE: $6,000,000 Limit for Unnamed/Unscheduled Locations; Specified Limits for Scheduled Locations. <br /> Coverage is provided for all medlcaI professionals currently or previously employed or contracted by the above Named Insured,but only for professional <br /> services performed for or on behalf of the above Named Insured. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Select Physical Therapy Holdings, Inc, ACCORDANCE WITH THE POLICY PROVISIONS. <br /> dba Select Physical Therapy <br /> c/o Select Medical Corporation AUTHOR IZED RE P R ES ENTATIVE <br /> 4716 Old Gettysburg Road <br /> Mechanicsburg PA 17055 <br /> D 1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD <br />