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Print Date: 08/07/09 <br />HEALTHCARE PROVIDERS <br />CNA 5 PURICHASRNG G OUP N <br />CERTIFICATE OF INSURANCE <br />OCCURRENCE POLICY FORM <br />.J//// %~ <br />018098 970 HPG 0298755008 from:12:01 AM Standard Time on: 08/01/09 <br />to: 12:01 AM Standard Time on: OB 01 10 <br />Wesle A Bosch - _ _ _••__•••- - - Healthcare Providers Service Organization <br />1000 ~ Santa Ana Blvd Ste 200 159 East County Line Road <br />Santa Ana, CA 92701-3900 Hatboro, PA 19040-1218 <br />MMarrral a%Farn Ity Counselor Code: 80723 •' - -- . •. • • .... ~ • . • • .... • . • . <br />g y American Casualty Company of Reading, Pennsylvania <br />333 S. UVabash Avenue, Chicago, IL 60604 <br />A. PROFESSIONAL LIABILITY <br />Professional Liability (PL) _ $ 1,000,000 each claim $ .3,000,000 aggregate <br />oc~Samanfan ClabTty __ included above .r: ' "''"" ~~~~~-~' ~~ <br />PerSOna nfi jury Liability included above ~~ , ':~ ` • '. - ^~~"~~..rx~~°~~r. <br />-„~,~.~- <br />B. COVERAGE EXTENSIONS: <br />- Icy ense ~rotectlon -~- 1~00~ er rocee m ~5~0~_~~re8ate__ <br />~ <br />Defendant Expense Benefit - ~ `~~ $ 10,000 aggregate <br />~ <br />n t~epresentatio <br />n <br />->~itio $ 2,50 per deposition $ 500 aggregate <br />_ <br />_ <br />_ <br />Assault $ 10,000 per incident $ 25,000 _ aggregate^ <br />Medical P~ments _ _ <br />_ <br />~ 2 OOfl _ <br />er arson 100,aoa_ aggrecLate _ <br />First Aid - ~~:• _ ~ - ~~=-= ' °• _$ 2,500_ ~gr_e ag to - <br />_ _ _ <br />_ <br />Damage to Property of Others $ 500 per incident $ 10,000 aggregate <br />G. t~11ORKPLACE LIABILITY Coverage part C. Workplace Lleblllry does not apply If Coverege part D. Generel Llablllty Is made part of ihla policy. <br />Workplace Liability included in A. PL limit shown above Y ___. ~. ~ _~_ <br />Fire & Water Legal Liability included in A. PL limit shown above sub'ect to $150,000 sub-limit <br />Personal Liability - ~' `s ;~ !~' • s '~~ 1,000,000 aggregate <br />D. GENERAL LIABILITY Coverage part D. Generel Liability does not apply if Coverege pert C. Workplace Liability is made part of this policy. <br />General Liability (GL) _ none none <br />lrFt ed~C~o ~ITn~cT u o none ~~: . ..11 ~ ~-• ~r~r•~' <br />Fire & Water Legal Liability _ <br />none none ____ <br />_ <br />Personal Liability <br />- ~;~,~„-„~;~•. •.r: •• none _ <br />_ _-,.w <br />i•J <br />Total: $ 2 4 0 . 0 0 QUESTIONS? CALL: 1-800-982-9491 ~ `~~{ ` ,, <br />G-121500-D G-121503-C G-121501-C1 G-145184-A <br />G-147292-A G-123846-D04 GSL3886 GSL3908 G-123828-B <br />AS T~ FpgNi <br />~pR~VED <br />Keeo this document in a safe I K 'd <br />~e...~r. X12 <br />Chairman of the Board <br />~, <br />iv <br />.~ <br />c. <br />~~r-#~olicv.~s188711433 <br />a {~ re ew ante or your insurance rdgs. ~-- <br />Lauta Stit ttot~ey `-j~ /~ ~ n ,, <br />nt C~t`I A (~ LYl/ 1'~" ~ <br />~ss~sta <br />Secretary <br />G-141241-A (07/2001) Coverage Change Date: Endorsement Change Date: <br />