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<br />CNA <br /> <br />HEAL THCARE PROVlDERS <br />SERVICE ORGANIZATION <br />PURCHASING GROUP <br />CERTIFICATE OF INSURANCE <br />OCCURRENCE POLICY FORM <br /> <br />Print Date OS/28/0'j <br /> <br /> <br />vIe c'~ P'/ f\ Bcy:~ch <br />1050-8 ~anl~ ~na Blvd Ste <br />Santa. Ana, CA 92701-3900 <br />~AediGal Specialty: <br />Mmnago/FamHY Counsolor <br /> <br />Code:S0723 <br /> <br />lean Casually Co. of Heading, PA <br />CN/I Plaza 268 Chicago, It 60685 <br />LIMITS Of LIABILITY <br /> <br />-J <br /> <br />~OVERAGEPART~ <br />A, PROFeSSIONAL LIABILITY <br /> <br />Professional Liability (PL) <br />G66dSarr1arllariLiabllJty " <br />Persorialllljliiy Liabilify ,. <br />M;:ilplaCeiiieTifUi:lbifily <br /> <br />J__ <br />, <br />I <br /> <br />1,000,000 <br />il1dudedi'lbove . <br />included above <br />includediiibove <br /> <br />each claim <br /> <br /> <br />B. COVERAGE EXTENSIONS; <br />License ProfecU6ii- <br />"..,...._,......,..,,-'" <br />Defendant Expense Benefit <br />be~)()sifion <br />A.ssaull <br /> <br /> <br />aggreg~)te <br />angregate <br />aggregHte <br />aggregate <br /> <br />Damage to <br /> <br />ag}] re\~ at e <br />aggregate <br /> <br />C, WORKPLACE LIABILITY <br /> <br />Coverage plJft C, \V.Ykplacn Lwbdit", docs nf)l Dpr/Y if Cover;:;~9~~ part 0 GC!l(.!fal U;~bjlily nmde part or H'l& poht.::y <br /> <br />Workplace Liability <br />Fire &. VVilierLeg<lIUi:ibllily <br />PersonalUilbility <br /> <br /> <br />sLtb:lirriit <br /> <br />O. GENERAL LIABILITY <br /> <br />Covernve part D, Genm(.ll LiabilBy ClOf~~\ not ~lppJy If Coverage Fart C, ~'VorkpI8oc Liability ff%Hie P-YJrt of this policy <br /> <br />Total <br /> <br /> <br />General Liability (GL) <br />Hired AulO&N6ii Owned AlltO <br />& W~';te'r[egaIUahility <br />Persorial LiabilH~- <br /> <br /> <br />Hft~ yom <br /> <br /> <br /># 188711433 <br /> <br />:<1 <br />...,r/ ~ <br />, '[-y--// J <br />~/ ,,,,,,...--{ "'-.,c.,.~, ;1...<< <br /> <br />;"t! <br /> <br />\r~c~~tv h <br /> <br />Ch3ltTnan of the 8G8rd <br /> <br />G-141241-A (07/2001) <br /> <br />Coverage Change Date: <br /> <br />Endorsement Change Dale <br /> <br /> <br />