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T.7e,.tt1......•o P.•m,i fta..c Qn.•vira <br /> <br />Healthcare Providers Service <br />CNA A/ Organization Purchasing <br />?..?Group <br />?'?11 Y' qr.,bD P <br />@YMr7f 4?.b1y??rM i' / / V 1?N -V .V`?-V HAburH,F'.wlJ.n£...Y.OKniut.nSO- <br />nmJRRENCE POLICY FORM <br />Producer Branch Prefix Policy Number Policy Period <br /> from: 12:01 AN Standard Time on:- 06/01/10 <br />018098 970 HPG 029875S008-8 to, 12,01 A n ar n: 08/Q1/11 <br />Nahncd Insured and Address Program Administrator <br />- Healthcare Providers Service organization <br />WESLEY A BOSCH 159 East County Line Road <br />1000 E SANTA ANA BLVD STE 200 <br />3900 Hatboro, PA 19040-1218 <br />SANTA ANA CA 92701- <br />Medical Specialty: Code: Insurance Provided by <br /> <br />Marriage/Family Counselor 80723 American Casualty Company of Reading, Pennsylvania <br /> 333 S. Wabash Avenue Chicago, IL 60604 <br />COVERAGE PARTS LIMITS OF LIABILITY <br />B. Coverage Extensions <br /> rev at <br />Defendant Benefit ag greg ate <br />D 1 i n R n n $10,000.00 p er deposition 10 0 0 a r ate <br />Assault 25 000.00 per incident $25, 000.00 a re ate <br /> <br />First Al $10, 000.00 ag greg ate <br />Damage of Property of Others $10 ooo.oO per incident $10, 000.00 ag greg ate <br />C. WORKPLACE LIABILITY Coverage part C. does not apply if Coverage part D. is made part of this <br /> <br />V. UENEHAL LIASILI I Y Covera <br />General Liability ge pare li. aueS not npphy « wvcix.gc P.IL <br />None 1. 1-, . <br />None <br /> <br />Fire & Water Legal Liability None None <br />Personal Liability None <br />Total $240.00 Premium reflects self-employed, full-time rate. <br />Policy forms and endorsements attached at inception QUESTIONS? CALL: 1-800-982-9491 <br />G-121500-D G-121501-C1 G-121503-C G-145184-A 0-147292-A GSL3886 GSL3908 G-123846-D04 <br />G-123828-B <br />ppPR®VED AS TQ FORM <br />K <br />Agsist LISA E. STOdC nt City Attorney /L- Master Policy: 188711433 <br />a <br />Keep this doconient in a safe place. This and <br />your cancelled d check act as proof of coverage. <br />Chairnhan of the Board <br />Secretary <br />0-141241-A (7/2001) 401 XX0000005-R100524RENHCP12rO5RIH5HM10144