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liberty <br />Internatimal <br />Healthcare Professional Liability It, Underwriters. <br />LIBERTY INSURANCE UNDERWRITERS INC. <br />(A Stock Insurance Company, hereinafter t1w "Company') <br />ENDORSEMENT NO.[ ] <br />Effective Date: 08/21/2014 <br />Policy Number! AHY-754318001 <br />Issued To: Felice Hernandez <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />INDIVIDUAL PRACTITIONER COVERAGES <br />This policy is amended by the addition of the following.- <br />1. <br />ollowing: <br />I. SUPPLEMENTAL LIABILITY <br />The Company will pay on behalf of the Insured all sums which the Insured shall become legally obligated to <br />pay as Damages because of Bodily Injury or Property Damage to which this insurance applies caused by an <br />Occurrence, during the Policy Period. <br />The Limit of Liability stated in the Declarations as applicable to "each Incident" or "each Occurrence" is the <br />limit of the Company's liability for all Damages for each Occurrence covered by the policy. This Limit of <br />Liability is separate from the Limit of Liability applicable to COVERAGES A. PROFESSIONAL LIABILITY <br />COVERAGE and B. GENERAL LIABILITY COVERAGE, of the policy. However, all Claims arising from <br />the same or related Occurrence shall be considered a single Claim for the purpose of this insurance and shall <br />be subject to the same Limit of Liability, <br />The Limit of Liability stated in the Declarations as "Aggregate" is, subject to the above provisions involving <br />"each Incident" or "each Occurrence", the total limit of the Company's liability under this policy for all <br />Damages tinder this coverage. <br />II. MEDICAL PAYMENTS <br />The Company will pay, in addition to the applicable Limit of Liability, up to $$1,500 per person, to or for each <br />person who sustains Bodily Injury caused by an Occurrence during the Policy Period: <br />A. while on the premises owned by or rented to the Insured with the permission of the Insured, or <br />B. while elsewhere if such Bodily Injury: <br />1. arises out of the premises owned by or rented to the Insured or a condition in the ways <br />immediately adjoining; <br />2, is caused by the activities of the Insured; or <br />3. is caused by the activities of, or is sustained by, a residence employee while engaged in the <br />employment of the Insured. <br />the reasonable expense of necessary medical, surgical, ambulance, hospital, professional nursing and funeral <br />services, all incurred within four (4) years from the date of Occurrence. <br />2 <br />14CPLr2151 (Ed. 11/09) <br />