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HEALTHCARE PROVIDERS SERVICE ORGANIZATION PURCHASING GROUP CNA Certificate ltmrance OCCURRENCE PROFESSIONAL LIABILITY POLICY FORM Print Date: 1/21/2026 The application for the Policy and any and all supplementary information, materials, and statements submitted therewith shall be maintained on file by us or our Program Administrator and will be deemed attached to and incorporated into the Policy as if physically attached. PRODUCER BRANCH PREFIX POLICY NUMBER POLICY PERIOD 018098 970 HPG 0697816243 From: 12/10/25 to 12/10/26 at 12:01 AM Standard Time Named Insured and Address: Program Administered by: Luis Martinez Healthcare Providers Service Organization 301 W 2nd St Apt 241 1100 Virginia Drive, Suite 250 Santa Ana, CA 92701-5295 Fort Washington, PA 19034 1-800-982-9491 www.hpso.com Medical Specialty: Code: Insurance Provided by: Alcohol/Drug Counselor 80723 American Casualty Company of Reading, Pennsylvania 151 N. Franklin Street Excludes Cosmetic Procedures Chicago, IL 60606 Professional Liability $ 1,000,000 each claim 3,000,000 aggregate Your professional liability limits shown above include the following: * Good Samaritan Liability * Malplacement Liability * Personal Injury Liability * Sexual Misconduct Included in the PL limit shown above subject to $25,000 aggregate sublimit Coverage Extensions License Protection $25,000 per proceeding $ 25,000 aggregate: Defendant Expense Benefit $ 1,000 per day limit $25,000 aggregate: Deposition Representation $ 10,000 per deposition $ 10,000 aggregate Assault $ 25,000 per incident $25,000 aggregate Includes Workplace Violence Counseling Medical Payments $ 25,000 per person $ 100,000 aggregate First Aid $ 10,000 per incident $ 10,000 aggregate Damage to the Property of Others $ 10,000 per incident $ 10,000 aggregate: Information Privacy (HIPAA) Fines and Penalties $ 25,000 per incident $25,000 aggregate, Media Expense $ 25,000 per incident $ 25,000 aggregate APPROVED General Liability By Tu Tran Nguyen at 10:21 am,Feb 19,2026 General Liability $1,000,000 each claim / $2,000,000 aggregate Fire &Water Legal Liability Included in the GL limit shown above subject to$250,000 aggregate sublimit Personal Liability $1,000,000 aggregate Total $ 465.00 Base Premium $465.00 Premium reflects Self Employed , Part Time Policy Forms and Endorsements (Please see attached list of policy forms and endorsements) Doug Worman, Chief Executive Officer Stathy Darcy, Secretary Keep this Certificate of Insurance in a safe place. It and proof of payment are your proof of coverage. There is no coverage in force unless the premium is paid in full. To activate your coverage, please remit premium in full by the effective date of this Certificate of Insurance. Coverage Change Date: Endorsement Date: Master Policy: 188711433 CNA93692 (11-2018)