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Issuing Company: <br />National Fire & Marine Insurance Company <br />Omaha, Nebraska <br />Forming Part of Policy No.: HN033337 <br /> <br />Issued to: Industrial Medical Support, Inc <br /> <br />Policy Period: From 03/15/2024 to 03/15/2025 at 12:01 a.m. at the address of the First Named <br />Insured stated herein. <br />SCHEDULE OF FORMS AND ENDORSEMENTS <br /> <br />Forms and Endorsements attached to this Policy: <br /> <br />ENDORSEMENT <br />FORM NAME FORM NUMBER NUMBER <br /> <br />Healthcare Liability Policy Declarations 0001-PXX-00-0121 <br /> <br />Schedule of Forms and Endorsements 0002-PXX-00-1215 <br /> <br />Schedule of Named Insureds - Professional Liability 0006-PPX-00-1215 <br /> <br />Schedule of Named Insureds - General Liability 0007-PGX-00-0717 <br /> <br />Schedule of Named Insureds - Cyber Liability and Breach Response 0008-PCX-00-0121 <br /> <br />Schedule of Trade, Fictitious and/or Business Names 0009-PXX-00-1215 <br /> <br />Healthcare Liability Policy Common Policy Provisions and Conditions 0010-PXX-00-0121 <br /> <br />Healthcare Liability Policy - Professional Liability Coverage Part 0011-PPF-00-0121 <br /> <br />Healthcare Liability Policy - General Liability Coverage Part 0012-PGX-00-0121 <br /> <br />Healthcare Liability Policy - Cyber Liability and Breach Response Coverage Part 0013-PCX-00-0121 <br />Schedule of Additional Insureds Endorsement 1120-PXX-00-0121 1 <br />Schedule of Additional Insureds - Primary and Non-Contributory with Notice of 1123-PXX-00-0121 2 <br />Cancellation Endorsement <br />Schedule of Waiver of Subrogation Endorsement 1128-PXX-00-1215 3 <br />Amended Definition of Employee Endorsement 1136-PXX-00-0121 4 <br />Policy Aggregate Limit Endorsement (Professional Liability & General Liability) 1173-PXX-00-0121 5 <br />1303-PPX-00-0121 6 <br />Disciplinary, Licensing and Credentialing Actions Endorsement (Professional <br />Liability) <br />1318-PPF-00-0121 7 <br />Intentional Acts Exclusion with Sublimits for Innocent Insureds Endorsement <br />(Professional Liability) <br />Blanket Per Location Limits of Liability Endorsement (Professional Liability) 1357-PPX-00-0121 8 <br />Employee Benefits Liability Endorsement (General Liability) (Claims-Made and 1504-PGX-00-0121 9 <br />Reported Coverage) <br />1507-PGX-00-0121 10 <br />Blanket Additional Insured - Primary and Non-Contributory Endorsement <br />(General Liability) <br />Blanket Waiver of Subrogation Endorsement (General Liability) 1512-PGX-00-1215 11 <br />Cap on Losses from Certified Acts of Terrorism Endorsement (General Liability) 1536-PGX-00-0520 12 <br />0002-PXX-00-1215 Page 1 of 2 © 2015 MedPro Group. All rights reserved. <br /> <br />