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Print Date: r1 ~ j ;~, j t ;,
<br />MIALTH~AE7E PR©VIDERS
<br />SERVICE ORGAIVtZATiON
<br />Pt,)RCHA51Nta GIv'C~1lP
<br />CERTiFICAfiE t7F INSllRANCE
<br />©CCURRENCE PnLICY 1=0Rt~t
<br />W _~._ .~,...r -~-.--- __~__ ~u~.._ -__
<br />f'ros~ucer,Br~~neh ,Prefix r~Pclicy'~Jur~ber Policy Period _ _
<br />018098 ?.".) i°ii'G ;1 ? r, ., ., .. ;; ~; r; orn , 2:~1 Af~~l ~>tarna.~~t~ l ir71 . ~~;. ~,,: Jt 87
<br />to 1'.01 A[;iI StanQard Tirnc or~~.~ Jt;08
<br />arced Ensured ar~tt Address: ~ Pro rangy Adminisiratar ~ __
<br />Tr>f~ , ~ i~ :> 7~ r ~ Naaltheare Rroviders Service Or~ani~:atinr~ ,
<br />1~ T~', :,fin': a ~~~,:~ :~ .~? ~;~~ 2ttr~ 159 East County Line E~tsad
<br />u,: :r_< ;~~r,a, C:~ `; E: `JCr1. - ~.~uC Hr3tboro„ P,~ 19040-1~1~
<br />_ ~
<br />!°1!cr'~c~l SpECEaity: y Code: Insurance Pr'avtded key ~~~~
<br />t.^a r~~~~~-;;f-r~miEy C~n~anse~lc~r ~rJ723 ~,rreri~.an ~;asualfy i:,+~ r E t~~,scirrrct, PA
<br />C1~r~1 Pte3Lr1 2~~ ~.tllt;c,;)i), i._ fsQU~:7
<br />__. .
<br />ouERA~E paiz~s LtMITS,t71= I_IASI~.ITY ~.~
<br />A. PR43P555tC7tVAt_ LtABELtTY
<br />..
<br />Profess~onai Liabrh#y ~~L} S 1,000 040.. each eia~im S '~ OOO,C~uCt ~nr7 ,,tat:
<br />_ - _. ~. _
<br />OY~'
<br />Pew ~ r~~ rlrtiu~y~~ Li~bitlrty+ included ,ab~_-. _._ _ _
<br />y
<br />`' included ab©ve
<br />,. _ _ ___ _
<br />_ ,- - __
<br />hq~llk~l~i_cnlertt Lidtlitity ; included above
<br />.._.. _ _ .. .._ _ ___ ..~. .-e_s-a_~_..._ __-....W~._.,r
<br />~. COVERAGE EXTENSIC?NS;
<br />License Protection
<br />Clefen~iarit Expense Benefit
<br />by e~~c~sit%an RerJreserif~tiort ...... __..
<br />n~~.i.,,ai Payrr~erats
<br />_.
<br />f r ~,t E~-.rc1
<br />Darr~cte to Prot~erty of Clthers
<br />C. VkItJRKPLACE C.IAF3ILITY
<br />149aster Policy ~ 188711433
<br />e.__-._~...__ _.._ m , .___ _ ..
<br />F,c• Is. draw. :;„~rt ¢t ,a &ate place. I( ar~s4 ~+rs~uf v. ~.~ym~nt art c.u~erice et gtxir a ....i.. ..r ~.. r.~ISIsY. __.......
<br />VSJor`kFatace Liability iinetuded in ~i. PL lirnif s?7ewrr b.,°,;;~
<br />)`=ire & 1~latet legal Liobtia#y ,rncluc'~rt fn A 'L Errni~ ~trua~n ' ~~e sut~j~ct to 51 ~~,C3C~0 sut~-lirtait
<br />Persoriai Liability f.. $1 000,000 ag~re~at~
<br />d. GENERAL L1A~ILETY C~=rer~r, ~~ , . ,'. Gr~:ural i~i:ats'~IiSy [9x~ ~ ~; f,t%y it Overage Far, :%. 4V2r'kplar,e f.ruLiiiYy i;~ in ~a„9c* S>H"t eat this ?a;'licy.
<br />C;r.ri~~r; l LIEst~rttty (GL) __ ~ ri{}r1C~ ~ none
<br />__
<br />FirP~~~VU 7r &Nora awned Auto ~ . _ _ ni~~ne ___ ..,,,-.. -,
<br />_.. _ ~~ __
<br />c r,ai L.iab I~ty r7rstr~ ~. nc~rre -~ _ __ ._-...w
<br />' - ._.__.
<br />._.._
<br />- __
<br />Persona Liability ~_ _-- -~.. _.~_~_d____ none
<br />Tc~tai Prert~ium. 5 2~t?. Cry t,t,f_~j-;+,ti~~~t al,t~_ t ~~cxrr-~~~_Ua~~,
<br />-12.1 faJ-C G-:~21a'J?-~ t,-121.501-C°_ C~>51&~4-Fi
<br />~~-a.~x'7292-~ C~-~-4~.87~;-.~ C~-11~€?•4~i-I~;°4 G-~23~3'1.k3~-II ~ '.f
<br />,!"
<br />/r/ f A !~
<br />G-14" 241 _~ (~)i12(;'f}1)
<br />~ ~ a.a~~
<br />J ~,~J©
<br />?,000
<br />5 5o~i _..
<br />E~~r E~raceed~rri; ~ 25,000 .,r;r ., , _.
<br />~j
<br />__
<br />~,: ~~eF~~s,t.,~°7;
<br />~ ~
<br />
<br />~ 10,000
<br />
<br />5 000 tlfr ~ ,sae
<br />
<br />
<br />c:~ f 1. <~i~
<br />~ a
<br />
<br />
<br />
<br />_._-~.. _~ 2.5x00
<br />_ <~q~arer~ate_
<br />perinc;ident! ~ 1G.f7t7fl i+~lregaf~,>
<br />Ccyvtera;7c yiart C 1"v ,rRphxuu L3r;n!iEy , °,J tt~,>;y Gf C„wtoi r;~_, par. J. ~aenar.~I i.„~~;,~ts is r~3 ;:It; t~~'? sir 3 r ,w'ir_y
<br />~ecr~ta'Y
<br />Coverage Gttrarxg~= Date:
<br />25.A.-20
<br />Ertdr~rsernF~nt Ct;arrt~e C.?ate:
<br />
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