Loading...
HomeMy WebLinkAbout2017-296-E Aging - Lorraine Lewis for wellness instructor DocuSign Envelope ID:656DF690-72BC-42BC-9E47-7038084D8FFA [Departmental Use Only] TITLE Wellness Instructor FY 2017-18 ORANGE COUNTY CONTRACT UNDER $15,000.00 NORTH CAROLINA THIS AGREEMENT, made and entered into this first day of July, 2017, ("Effective Date")by and between Orange County, North Carolina, a political subdivision of the State of North Carolina, (the "County"),party of the first part; and Lorraine Lewis (the "Provider"),party of the second part; WITNESSETH: For the purpose and subject to the terms and conditions hereinafter set forth, the County hereby contracts for the services of the Provider, and the Provider agrees to provide the following services to the County in accordance with the terms of this Agreement, time being of the essence: The services and/or materials (hereinafter referred to collectively as "Services") to be furnished under this Agreement are as follows: Trager and Reiki therapy sessions bi-monthly by appointment The term of this agreement rendered shall be from July 1, 2017 to June 30, 2018. Provider represents and agrees that Provider is qualified to perform and fully capable of performing and providing the services required or necessary under this Agreement in a fully competent, professional and timely manner to the satisfaction of the County. Provider shall be responsible for all errors or omissions, in the performance of the Agreement. Provider shall correct any and all errors, omissions, discrepancies, ambiguities,mistakes or conflicts at no additional cost to the County. Provider agrees that Provider shall not sub-contract any of the services to be provided in this Agreement, nor shall Provider assign any right or responsibility granted or required by this Agreement, without the prior written approval of the County. SPECIFIC TERMS 1. Payment: The County agrees to pay at the rates specified for Services satisfactorily performed in accord with this Agreement. The amount to be paid by the County shall not exceed the lesser of 90% of the total client fees collected or one-thousand, five-hundred dollars, ($1,500). Payment shall be made within thirty (30) days of an invoice properly submitted to County. Should Provider fail to perform its duties under the terms of this Agreement, County may, without fault or penalty, withhold any payment associated with the work to be performed until such time as said work is completed. 2. Non—waiver: Failure by County at any time to require the performance by Provider of any of the provisions hereof shall in no way waive or affect the County's right hereunder to enforce the same, nor shall any waiver by the County of any breach be held to be a waiver of any succeeding breach or a waiver of this Non-Waiver Clause. 3. Independent Contractor: The Provider shall operate as an independent contractor and the County shall not be responsible for any of the Provider's acts or omissions. The Provider shall not be treated as an employee with respect to the Services performed hereunder for federal or state tax, unemployment or workers' compensation purposes. The Provider understands that neither federal, nor state, nor payroll tax of any kind shall be withheld or paid by the County on behalf of the Provider or the employees of the Provider. 4. Insurance: Provider shall obtain, at its sole expense, Commercial General Liability Insurance, Automobile Insurance, Workers' Compensation Insurance, and any additional insurance as may be required by County's Risk Manager as such insurance requirements are described in the Orange County Risk Transfer Policy and Orange County Minimum Insurance Coverage Requirements (each document is incorporated herein by reference and may be viewed at Revised 2/17 1 DocuSign Envelope ID:656DF690-72BC-42BC-9E47-7038084D8FFA http://www.orangecountync.gov/departments/purchasing division/contracts.php). if County's Risk Manager determines additional insurance coverage is required such additional insurance shall consist of personal liability insurance (if no additional insurance required mark N/A as being not applicable). Provider shall not commence work until such insurance is in effect and certification thereof has been received by the County's Risk Manager. 5. Indemnity: The Provider agrees to defend, indemnify, and hold harmless Orange County from all losses, liabilities, claims, demands, suits, costs, damages or expenses (including reasonable attorney's fees) arising from bodily injury, including death, to any person or persons or damage to or destruction of any property caused in whole or in part by any negligent or intentional act or omission on the part of the Provider, its agents, or assigns directly or indirectly related to the Services to be performed pursuant to this Agreement on the part of the Provider. 6. Termination: This Agreement may be terminated at any time by mutual written agreement of the parties or by the County upon written notice to the Provider. County may suspend this Agreement upon reasonable notice to the Provider. 7. Entire Agreement and Signatures: The parties have read this Agreement and agree to be bound by all of its terms, and further agree that it constitutes the complete and exclusive statement of the Agreement between the parties unless and until modified in writing and signed by the parties. This Agreement together with any amendments or modifications may be executed electronically. All electronic signatures affixed hereto evidence the consent of the Parties to utilize electronic signatures and the intent of the Parties to comply with Article 11A and Article 40 of North Carolina General Statute Chapter 66. 8. Priority: In determining the basic services to be provided, should any documents be referenced in or attached to this Agreement, the terms of this Agreement shall have priority in any conflict between the terms of referenced documents and the terms of this Agreement. 9. Governing Law: Both parties agree that this Agreement shall be governed by the laws of the State of North Carolina. Provider shall at all times remain in compliance with all applicable local, state, and federal laws, rules, and regulations including but not limited to all state and federal anti-discrimination laws, policies, rules, and regulations and the Orange County Non-Discrimination Policy and Orange County Living Wage Policy (each policy is incorporated herein by reference and may be viewed at http://www.orangecountync.gov/departments/purchasing_division/contracts.php.). Any violation of this requirement is a breach of this Agreement and County may immediately terminate this Agreement without further obligation on the part of the County. This paragraph is not intended to limit and does not limit the definition of breach to discrimination. By executing this Agreement Provider affirms that Provider is and shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. By executing this Agreement Provider certifies that Provider has not been identified, and has not utilized the services of any agent or subcontractor, on the list created by the State Treasurer pursuant to G.S. 147-86.58. 10. Dispute Resolution: Any and all suits or actions to enforce, interpret, or seek damages with respect to any provision of, or the performance or non-performance of, this Agreement shall be brought in the General Court of Justice of North Carolina sitting in Orange County, North Carolina. It is agreed by the parties that no other court shall have jurisdiction or venue with respect to such suits or actions. Binding arbitration may not be initiated by either Party, however, the Parties may agree to nonbinding mediation of any dispute prior to the bringing of such suit or action. 11. Non Appropriation: Provider acknowledges that County is a governmental entity, and the validity of this Agreement is based upon the availability of public funding under the authority of its statutory mandate. In the event that public funds are unavailable and not appropriated for the performance of County's Revised 2/17 2 DocuSign Envelope ID:656DF690-72BC-42BC-9E47-7038084D8FFA obligations under this Agreement, then this Agreement shall automatically expire without penalty to County immediately upon written notice to Provider of the unavailability and non-appropriation of public funds. [SIGNATURE PAGE TO FOLLOW] Revised 2/17 3 DocuSign Envelope ID:656DF690-72BC-42BC-9E47-7038084D8FFA IN WITNESS WHEREOF,County and the Provider have signed this Agreement, effective as of the day first written above. ORANGE COUNTY PROVIDER ,----DocuSigned by: DocuSigned by: By: IjNlabt,lt, t'a.wkwit,Y's(,ui By: (,bVnu-t u (,t,wis CQy3ar... Title: `-60F1AC57DCF044C... 200 S. Cameron St. Lorraine Lewis P.O. Box 8181 107 Morningside Drive Hillsborough,NC 27278 Carrboro, NC 27510 Revised 2/17 4 DocuSign Envelope ID:656DF690-72BC-42BC-9E47-7038084D8FFA Mercer Consumer,a service of MI MERCER Mercer Health&Benefits Administration LLC P.O.Box 14576 Des Moines,IA 50306-3576 www.proliability.com May 31,2017 Lorraine Lewis 107 Morningside Drive Carrboro,NC 27510-1254 Re: Allied Health Professional Liability Customer Number: 073937 Policy Number: AHX-102357006 Expiration Date: 06/01/2018 Dear Lorraine Lewis, I am pleased to enclose your insurance policy through the Liberty Insurance Underwriters Inc. Please review the material carefully and take specific notice of any endorsements to the policy.These policy documents should be kept with your important papers. Please note the important information below: Address or Mid-Term Changes:Any change of address or request for mid-term change should be sent to the following address to assure timely receipt of future notices. All requests must be signed and dated by the policy holder. Also note that requests for mid-term changes to your coverage must be approved by an underwriter prior to binding coverage. Mercer Consumer,a service of Mercer Health&Benefits Administration LLC P.O.Box 14576 Des Moines,IA 50306-3576 Fax:212-948-1509 Phone: 1-800-503-9230 If you have any questions, please contact our office Monday through Friday from 8:15 a.m.to 5:00 p.m. (CT). Thank you for the opportunity to serve your insurance needs. Sincerely, Mark Brostowitz Principal Mercer Consumer Enclosure Federation Renewal Submission MARSH&McLENNAN COMPANIES TALENT• HEALTH • RETIREMENT• INVESTMENTS DocuSign Envelope ID:656DF690-72BC-42BC-9E47-7038084D8FFA NOTICE CLAIM REPORTING INSTRUCTIONS In the event you receive notice of a Claim, Suit, Incident or Occurren ce, you must provide written notice to Liberty Insurance Underwriters Inc. (LIUI). A claim must be reported to LIUI for assignment to a Claims Professional. Please follow the instructions below: Please send written notice to: MercerClaims@libertyiu.com OR Liberty International Underwriters Attn: Mercer Claims 55 Water Street 23rd Floor New York, NY 10041 If you would like to speak with someone regarding your Claim, Suit, Incident or Occurrence, please contact: 1-855-511-8097 Terms in bold face are defined by your policy. Please refer to your policy for relevant definitions and reporting obligations. LIUI HPL CLN001 (Ed. 06/15) DocuSign Envelope ID:656DF690-72BC-42BC-9E47-7038084D8FFA Healthcare Professional Liability c%li # pig h ote natitzaaal Und r4,rat LIBERTY INSURANCE UNDERWRITERS INC. (1 Stock Insurance Company,hereinafter the"Company") 55 Water Street,18a Floor New York,NY 10041 CERTIFICATE OF INSURANCE HEALTHCARE PROFESSIONAL LIABILITY CLAIMS-MADE INSURANCE POLICY FOR MEMBERS OF THE FEDERATION Item CERTIFICATE NUMBER: AHX-102357006 RENEWAL OF: AHX-102357005 1. NAMED INSURED Lorraine Lewis 2. MAILING ADDRESS 107 Morningside Drive Carrboro,NC 27510-1254 3 Policy Period 12:01 A.M.Standard Time From: 06/01/2017 To: 06/01/2018 At Location of Designated Premises 4. Prior Acts Date: 06/13/1993 5. COVERAGE LIMITS OF LIABILITY PREMIUM Professional Liability $1,000,000 each Incident $3,000,000 Aggregate $93.00 Terrorism Risk Insurance Act $0.00 $0.00 6. Deductible(if applicable) $0 each Incident Total: $93.00 7. The Named Insured is: N Sole Proprietor(including Independent Contractors) ❑Partnership ❑ Corporation ❑ Other: Affiliation: 3410-Trager Approach Prof Liability 8 Business or Occupation of the Named Insured:AS STA'L'ED IN THE MAS'T'ER POLICY DECLARATIONS OR,IF APPLICABLE,AS ENDORSED HEREON This policy is made and accepted subject to the printed conditions of this policy together with the provisions,stipulations and 9' agreements contained in the following form(s)or endorsement(s): HCPL-2026(11/09),HCPL-2038(11/09),HCPL-8002 (11/09),HCPL-8004(11/09) HCPL-8005 (11/09),HCPL-8086(12/10),HCPL-8001 (11/09), OFAC (08/09),HCPL-2026-9000-NC(4/10) REPRESENTATIVE: Mercer Consumer,a service of Agent: Mercer Health&Benefits Administration LLC Office Address: P.O.Box 14576 Des Moines,IA 50306-3576 1 HCPL-2026D(11/09) DocuSign Envelope ID:656DF690-72BC-42BC-9E47-7038084D8FFA Client #073937 MEMORANDUM OF INSURANCE Date Issued 05/31/2017 Producer This memorandum is issued as a matter of information only and confers no rights upon the holder. This Mercer Consumer, a service of memorandum does not amend, extend or alter Mercer Health& Benefits Admi ni strati on LLC coverages afforded by the Certificate listed below. P.O. Box 14576 Des Moines, IA 50306-3576 1-800-503-9230 Company Affording Coverage Insured Liberty Insurance Underwriters Inc Lorraine Lewis 107 Morningside Drive Carrboro NC 27510-1254 This is to certify that the Certificate listed below has been issued to the insured named above for the policy period indicated, not withstanding any requirement, term or condition of any contract or other document with respect to which this memorandum may be issued or may pertain,the insurance afforded by the Certificate described herein is subject to all the terms, exclusions and conditions of such Certificate.The limits shown may have been reduced by paid claims. The Memorandum of Insurance and verification of payment are your evidence of coverage.No coverage is afforded unless the premium is successfully paid in full. Type of Insurance Certificate Number Effective Date Expiration Date Limits Professional Liability AHX-102357006 06/01/2017 06/01/2018 Per Incident/ $1,000,000 Federation Occurrence Annual Aggregate $3,000,000 PROOF OF INSURANCE Memorandum Holder: Should the above describe Certificate be cancelled PROOF OF COVERAGE ONLY before the expiration date thereof,the issuing company will endeavor to mail 30 days written notice to the Memorandum Holder named to the left, but failure to mail such notice shall impose no obligation or liability of any kind upon the company, its agents or representatives. Authorized Representative Maar^k Brostowitz "V VIQF t& Q. ' Mercer Consumer, a service of Mercer Health& Benefits Administration LLC. I n CA d/b/a Mercer Health& Benefits Insurance Services LLC. CA Ins Li c. #0G39709 DocuSign Envelope ID:656DF690-72BC-42BC-9E47-7038084D8FFA Itr Healthcare Professional Liability l - AN international Liability . LIBERTY INSURANCE UNDERWRITERS INC. (A Stock Insurance Company,hereinafter the"Company") HEALTHCARE PROFESSIONAL LIABILITY CLAIMS-MADE INSURANCE POLICY THIS IS A CLAIMS-MADE POLICY. PLEASE READ IT CAREFULLY. THE POLICY IS LIMITED TO LIABILITY FOR ONLY THOSE CLAIMS THAT ARE FIRST MADE AGAINST THE INSURED AND REPORTED TO THE COMPANY DURING THE POLICY PERIOD UNLESS,AND TO THE EXTENT, THE EXTENDED REPORTING PERIOD OPTION APPLIES. The Company agrees with the Named Insured,in consideration of the payment of the premium,and in reliance upon the statements in the Declarations and in the Application, and subject to the Limit of Liability, exclusions, conditions and other terms of this policy,as follows: I. COVERAGE The Company will pay on behalf of the Insured all sums which the Insured shall become legally obligated to pay as Damages for Claims first made against the Insured and reported to the Company during the Policy Period or Extended Reporting Period, if applicable, as a result of Bodily Injury, Property Damage or Personal Injury caused by an Incident,provided always that such Incident happens: A. on or after the policy effective date shown on the Declarations;or B. on or after the effective date of the earliest Claims-Made Policy issued by the Company of which this policy is a renewal;or C. at any time prior to the policy effective date shown on the Declarations if: 1. such Incident happens on or subsequent to the"Prior Acts Date"on the Declarations;and 2. no Insured knew or could reasonably foreseen that such Incident might be expected to be the basis of a Claim or Suit on the effective date of this policy or the first Claims-Made Policy issued by the Company to which this policy is a renewal,whichever is earlier. The Company will pay on behalf of the Insured all sums which the Insured shall become legally obligated to pay as Damages to which this insurance applies and the Company shall have the right and duty to defend any Suit against the Insured seeking Damages on account of such Bodily Injury, Property Damage or Personal Injury,even if any of the allegations of the Suit are groundless,false or fraudulent,but the Company shall not be obligated to pay any Claim or Claim Expenses or judgments or continue to defend any Suit after the applicable limit of the Company's liability has been exhausted by payment of judgments or settlements. The Company,at its option,shall select and assign defense counsel;however,the Named Insured may engage additional counsel, solely at their expense, to associate in their defense of any Claim covered hereunder. Claim Expenses incurred by the Company shall be paid in addition to the applicable Limit of Liability. The Company shall also have the right to investigate any Claim and/or negotiate the settlement thereof,as it deems expedient, but the Company shall not commit the Named Insured to any settlement without their written consent. If the Named Insured refuses to consent to any settlement recommended in writing by the Company and elects to contest the Claim or continue any legal proceedings in connection with such Claim, then the Company shall be relieved of any further duty to defend the Claim,and the liability of the Company for Damages and Claim Expenses shall not exceed the amount for which the Claim could have been settled as well as the Claim Expenses incurred by the Company or with the Company's consent up to the date of refusal. The Insured shall not assume any obligations,incur any costs,charges,or expenses or enter into any settlement without the Company's written consent. 10 HCPL-2026(Ed. 11/09) DocuSign Envelope ID:656DF690-72BC-42BC-9E47-7038084D8FFA 4E1' ,!1)4/1'1 Healthcare Professional Liability II. PERSONS INSURED Each of the following is an Insured under this policy to the extent set forth below: A. If the Named Insured is an individual,the Named Insured so designated in the Declarations; B. If the Named Insured is a sole proprietorship,the Named Insured so designated in the Declarations; C. If the Named Insured is a partnership,the partnership so designated and any current or former partner thereof; D. If the Named Insured is other than a sole proprietorship or partnership, the organization so designated and any current or former owner,officer,director,trustee or stockholder thereof; E. Any current or former employee of the Named Insured, but only while such employee was acting on behalf of the Named Insured and within the scope of the employee's duties as such or for acts performed by such employee as a Good Samaritan or unpaid volunteer during the employee's term of employment with the Named Insured; F. Any person or entity listed as an Additional Insured on a Claims-Made Policy issued by the Company to which this policy is a renewal, but only for Incidents which happen during the time the Additional Insured Endorsement listing such person or entity was in force and solely for Incidents which are covered under the policy resulting from the sole negligence of the Named Insured or any employee thereof while acting within the scope of their duties for,and on behalf of,the Named Insured; G. Any volunteer,but solely while such person was acting within the scope of the volunteer's duties for,and on behalf of the Named Insured. III. LIMIT OF LIABILITY Regardless of the number of Insureds under this insurance,the number of persons and/or organizations who sustain Bodily Injury, Property Damage and/or Personal Injury or the number of Claims made or Suits brought,the Company's liability is limited as follows: A. The Limit of Liability stated in the Declarations as applicable to "each Incident"is the total limit of the Company's liability for all Damages for each Incident covered by the policy, including any Extended Reporting Period. All Claims arising from the same or related Incident shall be considered a single Claim for the purpose of this insurance and shall be subject to the same Limit of Liability. B. The Limit of Liability stated in the Declarations as "Aggregate" is, subject to the above provisions involving "each Incident", the total limit of the Company's liability under this policy, including any Extended Reporting Period,for all Damages. The purchase of any Extended Reporting Period option shall not increase the Limit of Liability available under this insurance. IV. DEDUCTIBLE The Insured shall pay Damages and/or Claim Expenses for each Incident or Occurrence equal to the amount of the Deductible,if any specified in the Declarations. The Company's obligation to pay Damages and Claim Expenses on behalf of the Insured resulting from a Claim shall be in excess of the Deductible amount stated in the Declarations. 10 HCPL-2026(Ed. 11/09) DocuSign Envelope ID:656DF690-72BC-42BC-9E47-7038084D8FFA 4E1' ,!1)4/1'1 Healthcare Professional Liability POLICY PERIOD, IERRITORY The insurance afforded by this policy applies to Claims which are first made and reported during the Policy Period for Incidents which occur anywhere in the world,provided Claim is made or Suit,if any,is brought within the United States of America,its territories or possessions,or Canada. VI. WHEN CLAIM IS TO BE CONSIDERED AS FIRST MADE A Claim shall be considered as being first made at the earlier of the following times: A. when the Company first receives written notice from the Insured that a Claim has been made;or B. when the Company first receives written notice from the Insured of specific circumstances involving a particular person or entity which may result in a Claim. All Claims arising out of the same or related Incident shall be considered as having been made at the time the first such Claim is made,and shall be subject to the same Limit of Liability and only a single Deductible,if any, shall apply. VII. SUPPLEMENTARY PAYMENTS The Company will pay,in addition to the applicable Limit of Liability up to $500 for loss of earnings to each individual Insured for each day or part of a day of such Insured's attendance at the Company's request at a trial,hearing or arbitration proceeding involving a civil Suit against such Insured for covered Damages,but the amount so payable for any one or series of trials,hearings or arbitration proceedings arising out of the same Incident shall in no event exceed$7,500. VIII. EXCLUSIONS This insurance shall not apply: A. to any obligation for which any Insured or any carrier as their insurer may be held liable under any workers'compensation,unemployment compensation or disability benefits law,or under any similar law; B. to Bodily Injury or Personal Injury to any employee of the Insured arising out of and in the course of his/her employment by the Insured or to any obligation of the Insured to indemnify another because of the Damages arising out of such injury; C. to any Claim,action,judgment,liability,settlement,loss defense,cost or expense in anyway arising out of actual, alleged or threatened pollution, contamination or any environmental impairment resulting from seepage,discharge,dispersal,release or escape of any solid,liquid,gaseous or radioactive matter including, but not limited to, smoke vapors, soots, fumes,acids,alkalis, chemicals or toxic matter; or waste material (including materials to be recycled, reconditioned or reclaimed); or oil or other petroleum substances or derivatives (including any oil refuse or oil mixed with waste), or thermal or vibratory effect including,but not limited to, sound or noise, heat or cold, into or upon land, the atmosphere or any water course or body of water, underground water or water table supplies, whether such results directly, indirectly or in concurrence or in any sequence from the Insured's activities or the activities of others and whether or not such is sudden,gradual,accidental,intended, foreseeable,expected, fortuitous or inevitable and wherever or however such occurs. But this exclusion shall not apply to Bodily Injury or Property Damage caused by heat,smoke or fumes from a Hostile Fire unless such fire involves: 10 HCPL-2026(Ed. 11/09) DocuSign Envelope ID:656DF690-72BC-42BC-9E47-7038084D8FFA f: Wit Healthcare Professional Liability materials which are or were at any time used for the handling, storage, disposal, processing or treatment of waste;or 2. any premises,site or location: a. which is or was at any time used for handling,storage,disposal processing or treatment of waste or b. on which any Insured or contractors or subcontractors working directly or indirectly on any Insured's behalf are performing operations to test for,monitor, clean up,remove contain treat detoxify or neutralize,or in anyway respond to,or assesses the effects of pollutants: D. to any dishonest,fraudulent,criminal or malicious acts or omissions of any Insured; E. to Claims based on or arising out of services by the Insured, to the extent such services are not authorized or permitted by the laws of the state(s)in which the Insured practices or conducts business; F. to any Claim made by an employer against an Insured who is a salaried employee of such employer; G. to acts or omissions by any Insured expected or intended to cause Bodily Injury or Property Damage, regardless of whether or not such act or omission was intended to cause the specific Bodily Injury or Property Damage sustained. This exclusion shall not apply to any intentional act by or at the direction of the Insured which results in Bodily Injury,if such injury arises solely from the use of reasonable force for the purpose of protecting persons or property; H. to liability assumed by any Insured under any contract or agreement, except to the extent the Insured would be liable in the absence of such contract or agreement; I. to Claims brought against any Insured as a proprietor, owner, partner, manager, superintendent, or officer of any hospital,sanitarium,medical clinic,health maintenance organization,managed care facility or any other facility not specified in the Declarations or any endorsement thereto; J. to Claims arising out of services performed by any Insured as a physician, surgeon, dentist, nurse midwife, chiropractor, podiatrist, osteopath, psychiatrist, attorney, accountant, financial advisor, investment consultant or real estate or insurance agent or broker; K. to Claims brought against any Insured arising out of any trade, business, employment, profession or occupation other than as specified in the Declarations or any endorsement thereto; L. to Claims based on or arising out of the practice of the Insured's business or professional occupation as stated in the Declarations unless the Insured is properly licensed or certified by the laws of the state(s)in which the Insured practices or conducts business or is otherwise qualified to practice the Insured's business or professional occupation in the absence of such laws; M. to any Claims made or Suits brought against any Insured alleging,in whole or part: 1. physical assault, abuse, molestation, or habitual neglect, or licentious, immoral, amoral or other behavior that was committed, or alleged to have been committed,by the Insured or by any person for whom the Insured is legally responsible;and/or 2. sexual assault, abuse, or molestation, or licentious, immoral, amoral or other behavior which was threatened, intended to, lead to or culminated in, any sexual act whether committed intentionally, negligently,inadvertently or with the belief,erroneous or otherwise,that the other party is consenting and has the legal and mental capacity to consent thereto,that was committed,or alleged to have been committed by the Insured or by any person for whom the Insured is legally responsible. 10 HCPL-2026(Ed. 11/09) DocuSign Envelope ID:656DF690-72BC-42BC-9E47-7038084D8FFA 4E1' ,!1)4/1'1 Healthcare Professional Liability exclusion applies regardless of the legal theory or basis upon which the Insured is alleged to be legally liable or responsible,in whole or in part,for any Damages arising out of sexual and/or physical abuse,including but not limited to assertions of improper or negligent hiring,employment or supervision, failure to protect or warn the other party,failure to prevent the sexual abuse and/or physical abuse,failure to prevent assault and battery or failure to discharge the employee. However,notwithstanding the foregoing exclusion,the Insured shall be entitled to a defense as provided under the terms of the policy as to any Claim upon which Suit is brought for any such alleged behavior, unless a judgment or final adjudication adverse to any Insured or on admission by any Insured shall establish that such behavior caused,in whole or part,the injury claimed in such Suit. The Company shall not be required to appeal a judgment or final adjudication adverse to the Insured; N. to any Claim brought by or on behalf of any person employed by the Insured,any person who had been employed by the Insured or any person seeking employment by the Insured alleging any act or omission by an Insured with respect to the hiring, termination, compensation, or the tenure, term, condition, benefits or privilege of employment of any such person; O. to any Claim brought by or on behalf of any Insured under this policy against any other Insured under this policy,except if such Claim arises from services rendered in a patient or client relationship; P. as respects Personal Injury coverage,to Personal Injury arising out of: 1. the willful violation of a penal statute or ordinance committed by or with the knowledge or consent of the Insured, 2. the publication or utterance of a libel or slander, or a publication or utterance in violation of an individual's right of privacy if the first injurious publication or utterance of the same or similar material by or on behalf of the Named Insured was made prior to the effective date of this coverage, 3. libel or slander or the publication or utterance of defamatory or disparaging material concerning any person or organization or goods, products or services or in violation of an individual's right of privacy,made by or at the direction of the Insured with knowledge of the falsity thereof. IX. DEFINITIONS When used in this policy(including endorsement forming a part hereof): "Bodily Injury" means bodily injury, sickness or disease, mental anguish, psychological injury or emotional distress sustained by any person,including death at any time resulting there from; "Claim" means demand for money, or the filing of Suit naming the Insured and alleging a Bodily Injury, Property Damage or Personal Injury as a result of an Incident; "Claims Expenses"means: A. fees charged by an attorney(s) and or/ independent adjustor(s) designated by the Company and all other fees,costs and expense resulting from the investigation, adjustment,defense and appeal of a Claim, Suit or proceedings,arising in connection therewith,incurred by the Company or by the Insured with written consent of the Company but does not include salary charges or expenses of regular employees or officials of the Company: B. all costs taxed against the Insured in such Suits and all interest on the entire amount of any judgment therewith which accrues after entry of the judgment and before the Company has paid, tendered or deposited,whether in court or otherwise,the part of the judgment which does not exceed the limit of the Company's liability; 10 HCPL-2026(Ed. 11/09) DocuSign Envelope ID:656DF690-72BC-42BC-9E47-7038084D8FFA twit Healthcare Professional Liability premiums on appeal bonds and premiums on bonds to release attachments in such Suits, but not for bond amounts in excess of the applicable Limit of Liability of this policy,but the Company shall have no obligation to apply for or furnish any such bond; "Damages"means compensatory judgments,settlement or awards but does not include punitive or exemplary Damages, fines or penalties,the return of fees or other consideration paid to the Insured, or the portion of any award or judgment caused by the multiplication of actual Damages under federal or state law.However,if a Suit is brought against the Insured with respect to a Claim for alleged acts or omissions falling within the scope of coverage afforded by this insurance seeking both compensatory and punitive or exemplary Damages, then the Company will afford a defense to such action,without liability however,for payment of such punitive or exemplary damages; "Hostile Fire"means one which becomes uncontrollable or breaks out from where it was intended to be; "Incident"means any act or omission; A. In the rendering of or failure to render services by the Insured,or by any person for whom the Insured is legally responsible,in the conduct of the business or professional occupation specified in the Declarations; or B. In the performance of services by any Insured as a member of a formal accreditation,ethics,peer review, licensing boards, standards review or similar professional board or committee of a professional not-for- profit organization, in the conduct of the Insured's business or in the practice of the Insured's professional occupation. Any such act or omission together with all related acts or omissions shall be considered on"Incident"and be subject to the same Limit of Liability; "Insured" means any person or organization qualifying as an Insured in the "Persons Insured" provision. The insurance afforded applies separately to each Insured against whom Claim is made or Suit is brought, except with respect to the limits of the Company's liability; "Named Insured" means the person or organization named in Item 1. of the Declarations of this policy. "Named Insured" also shall include any organization which is acquired or formed by the Named Insured and over which the Named Insured maintains ownership or majority interest, other than a joint venture, provided this insurances does not apply to Bodily Injury,Property Damage or Personal Injury if such new organization is also an insured under any other similar liability or indemnity policy,or would be insured under any such policy,but for exhaustion of its limits of liability.Unless written notice is given to the Company,this coverage shall terminate ninety (90) days from the date any such organization is acquired or formed by the Named Insured,or the end of the Policy Period whichever is earlier,and shall only apply to Claims brought against the Insured arising out of the business,profession or occupation specified in the Declarations; "Personal Injury"means injury resulting from: A. false,detention or imprisonment,or malicious prosecution; B. the publication or utterance of a libel or slander or of other defamatory or disparaging material, or a publication or utterance in violation of an individual's right of privacy; C. wrongful entry or eviction,or other invasion of the right of private occupancy; "Policy Period"means,whenever used in this policy,the period from the inception date of this policy to the policy expiration date as set forth in the Declarations or its earlier termination date,if any; 10 HCPL-2026(Ed. 11/09) DocuSign Envelope ID:656DF690-72BC-42BC-9E47-7038084D8FFA f: Healthcare Professional Liability Damage"means: A. physical injury to or destruction of tangible property, including the loss of use thereof at any time resulting therefrom; B. loss of use of tangible property which has not been physically injured or destroyed;or C. economic loss,whether or not resulting from physical injury or damage to person or property,except if such loss was caused,or alleged to have been caused,in whole or part,by anti-trust,price-fixing,restraint of trade or unfair business practices by any Insured; "Suit" includes lawsuits and arbitration proceedings to which the Insured is required to submit to or which the Insured has submitted with the Company's consent. X. CONDITIONS A. ASSISTANCE AND COOPERATION OF INSURED IN THE EVENT OF CLAIM OR SUIT Upon the Insured becoming aware of any Incident which could reasonably be expected to be the basis of a Claim covered hereby,written notice shall be given by the Insured to the Company together with the fullest information obtainable. If Claim is made or Suit is brought against the Insured,the Insured shall as soon as practicable forward to the Company every demand,notice,summons or other process received by the Insured or the Insured's representative. The Insured shall cooperate with the Company, and upon the Company's request, assist in making settlements,in the conduct of Suits and in enforcing any contribution or indemnity against any person or organization that may be liable to the Insured because of Damages with respect to which this insurance applies. The Insured shall attend hearings and trials and assist in securing and giving evidence and obtaining the attendance of witnesses; and the Company shall reimburse the Insured for reasonable expenses incurred at the Company's request.The Insured shall not, except at the Insured's own cost, voluntarily make any payments, assume any obligation or incur any expense. B. ASSIGNMENT The interest of any Insured is not assignable. If any Insured shall die or be adjudged incompetent, this insurance shall thereupon terminate for such person but shall cover the Insured's legal representative as the Insured with respect to liability previously incurred and covered by this insurance. Pro-rata return premium will be computed from the date of termination. C. ACTION AGAINST COMPANY No action shall lie against the Company unless,as a condition precedent thereto,there shall have been full compliance with all the terms of this policy,but not until the amount of Insured's obligation to pay shall have been finally determined either by judgment against the Insured after actual trial or by written agreement of the Insured,the claimant and the Company. D. OTHER INSURANCE If there is other valid insurance (whether primary, excess, contingent or self-insurance) which may apply against a loss or claim covered by this policy, the insurance provided hereunder shall be deemed excess insurance over and above the applicable limit of all other insurance or self-insurance. When this insurance is excess,the Company shall have no duty under this policy to defend any Claim or Suit that any other insurer or self-insurer has a duty to defend. If other insurer or self-insurer refuses to • 10 HCPL-2026(Ed. 11/09) DocuSign Envelope ID:656DF690-72BC-42BC-9E47-7038084D8FFA 4 Healthcare Professional Liability such Claim or Suit, the Company shall be entitled to the Insured's rights against all such other insurers or self-insurers for any Claims Expenses incurred by the Company. When both this insurance and other insurance or self-insurance apply to the loss on the same basis, whether primary, excess or contingent, the Company shall not be liable under this policy for a greater proportion of the loss or defense costs than the applicable Limit of Liability under this policy for such loss bears to the total applicable Limit of Liability of all valid and collectible insurance against such loss. Subject to the foregoing,if a loss occurs involving two or more policies, each of which provides that its insurance shall be excess,each will contribute pro-rata. E. SUBROGATION In the event of any payment under this policy,the Company shall be subrogated to all the Insured's rights of recovery therefore against any person,organization or entity and the Insured shall execute and deliver instruments and papers and do whatever else is necessary to secure such rights. The Insured shall do nothing after any loss to prejudice such rights. F. CHANGES The terms of this policy shall not be waived or changed,except by endorsements issued to form a part of this policy. G. BANKRUPTCY OR INSOLVENCY OF INSURED Bankruptcy or insolvency of the Insured or of the Insured's estate shall not relieve the Company of any of its obligations hereunder. H. C ANCELL ATION This insurance may be cancelled on the customary short rate basis by the Named Insured at any time by written notice or by surrender of this insurance to the Company or its authorized representative and the Company shall refund the paid premium less the earned portion thereof within thirty(30)days of the latter of the effective date of cancellation or the date of delivery of the Insured's notice of intent to cancel. This insurance may also be cancelled,with or without the return or tender of the unearned premium,by the Company or by its authorized representative on its behalf,by sending to the Named Insured,by first- class registered or certified mail, at the Named Insured's address last known to the Company or its authorized agent, not less than ninety (90) days written notice stating the specific reason for such cancellation and when the cancellation shall be effective. In such case the Company shall refund the paid premium less the earned portion thereof within ten (10) business days after the effective date of cancellation, subject always to the retention by the Company of any minimum premium stipulated herein (or proportion thereof previously agreed upon)in the event of cancellation either by the Company or the Named Insured. In case of nonpayment of premium, only thirty (thirty) days written notice of cancellation must be given by the Company. Cancellation by the Company shall only be effective if based on one or more of the following reasons: 1. nonpayment of premium; 2. the policy was obtained through a material misrepresentation; 3. violation of any of the terms and conditions of the policy; 4. the risk originally accepted has measurably increased;or 5. loss by the Company of reinsurance which provided coverage for all or a substantial part of the risk insured. I. NONRENEWAL j j 10 HCPL-2026(Ed. 11/09) DocuSign Envelope ID:656DF690-72BC-42BC-9E47-7038084D8FFA f: Healthcare Professional Liability Company will renew this policy unless written notice of the Company's intent not to renew, stating the specific reasons for nonrenewal,is mailed to the Named Insured not less than sixty(60) days before the policy expires. Any notice of nonrenewal will be mailed by first-class registered or certified mail to the Named Insured at the last mailing address known to the Company.Proof of mailing will be sufficient proof of notice. J. EXTENDED REPORTING PERIOD OPTION In the case of: 1. cancellation or nonrenewal of this policy by the Named Insured or the Company for any reason other than flat cancellation by the Company effective at policy inception for non-payment of premium;or 2. advancing a retroactive or prior acts date from one previously applied by the Company: this policy will automatically be extended for a period of sixty (60) days from the date of such cancellation or non-renewal,but only for Incidents committed on or after any applicable retroactive date and prior to the effective date of such cancellation or non-renewal (Automatic Extended Reporting Period). Furthermore, the Named Insured shall have the right, subject to the terms and conditions of this policy,or an endorsement attached thereto,to have an endorsement issued extending the time during which Claims can be reported(Supplemental Extended Reporting Period) for an additional premium of: i. 900/0 of the full annual premium for this policy,to a period of twelve(12)months; ii. 135%of the full annual premium for this policy,to a period of twenty-four(24)months; iii. 150%of the full annual premium for this policy,to a period of thirty-six(36)months;or iv. 1750/0 of the full annual premium for this policy,to a period of sixty(60)months following the effective date of such cancellation or nonrenewal in which to give written notice to the Company of Claims first made against the Insured during this Supplemental Extended Reporting Period for any Incident occurring prior to the termination of the final Policy Period, subject to its terms, limitations, exclusions and conditions. This right shall terminate sixty (60) days after the effective date of such action as is indicated in Subparagraphs(1.) or(2.)above unless written notice of such election, together with the additional premium is received by the Company or its authorized agent from the Named Insured within that sixty(60)day period. At the commencement of any Supplemental Extended Reporting Period option, the entire premium therefore shall be deemed earned and the Company shall not be liable to return to the Named Insured any portion of the premium for the Extended Reporting Period. The fact that the period during which Claims must be first made against the Named Insured under this policy is extended by virtue of any Extended Reporting Period option shall not in any way increase the Limit of Liability of this policy. The Limit of Liability available under any Extended Reporting Period Option shall be part of,and not in addition to,the Limit of Liability available under the last policy or renewal certificate issued to the Named Insured. K. DECLARATIONS AND APPLICATION By acceptance of this policy,the Insured agrees that the statements in the Declarations and Application are the Insured's agreements and representations and that this policy is issued in reliance upon the truth / 10 HCPL-2026(Ed. 11/09) DocuSign Envelope ID:656DF690-72BC-42BC-9E47-7038084D8FFA f Healthcare Professional Liability such representations and that this policy embodies all agreements existing between the Insured and the Company or any of its agents relating to this insurance. L. REIMBURSEMENT While the Company has no duty to do so,if the Company pays Damages or Claims Expenses: 1. within the amount of the applicable Deductible;and/or 2. in excess of the applicable Limit of Liability, all Insureds shall be jointly and severally liable to the Company for such amounts. Upon written demand,the Insured shall repay such amounts to the Company within(30)days thereof. M. PREMIUM All premiums for this policy shall be computed in accordance with the Company's rules,rates,rating plans, premiums and minimum premiums applicable to the insurance afforded herein. Premium designated in this policy is a deposit premium only which shall be credited to the amount of the earned premium due at the end of the Policy Period. At the close of each period (or part thereof terminating with the end of the Policy Period) designated in the Declarations as the audit period the earned premium shall be computed for such period and upon notice thereof to the Named Insured shall become due and payable. If the total earned premium for the Policy Period is less than the premium previously paid, the Company shall return to the Named Insured the unearned portion paid by the Named Insured. The Named Insured shall maintain records of such information as is necessary for premium computation,and shall send copies of such records to the Company at the end of the Policy Period and at such times during the Policy Period as the Company may direct. N. INSPECTION AND AUDIT The Company shall be permitted but not obligated to inspect the Named Insured's property and operations at any time.Neither the Company's rights to make inspections nor the making thereof nor any report thereon shall constitute an undertaking,on behalf of or for the benefits of the Named Insured or others,to determine or warrant that such property or operations are safe or healthful,or are in compliance with any law,rule or regulation. The Company may examine and audit the Named Insured's books and records at any time during the Policy Period and extensions thereof and within three(3)years after the final termination of this policy as far as they relate to the subject matter of this insurance. IN WITNESS WHEREOF,the Company has caused this policy to be signed by its President and Secretary. PRESIDENT VICE PRESIDENT and SECRETARY Christopher L.Peirce Mark C.Touhey /. 10 HCPL-2026(Ed. 11/09) DocuSign Envelope ID:656DF690-72BC-42BC-9E47-7038084D8FFA liberty €nte nazi nal U rd rc+,ra ers> Healthcare Professional Liability LIBERTY INSURANCE UNDERWRITERS INC. (.Stock Insurance Company,hereinafter the"Company") ENDORSEMENT NO. [ ] Effective Date: 06/01/2017 Policy Number: AHX-102357006 Issued To: Lorraine Lewis THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NUCLEAR ENERGY LIABILTIY EXCLUSION ENDORSEMENT BROAD FORM It is agreed that: The policy does not apply: A. Under any Liability Coverage,to Bodily Injury or Property Damage: (1) with respect to which an Insured under the policy is also an Insured under a Nuclear Energy Liability Policy issued by Nuclear Energy Liability Insurance Association,Mutual Atomic Energy Liability Underwriters or Nuclear Insurance Association of Canada,or would be an Insured under any such policy but for its termination upon the exhaustion of its Limit of Liability;or (2) resulting from the Hazardous Properties of Nuclear Material and with respect to which(a)any person or organization is required to maintain financial protection pursuant to the Atomic Energy Act of 1954,or any law mandatory thereof,or(b)the Insured is,or had this policy not been issued would be entitled to indemnity from the United States of America or any agency thereof,under any agreement entered into by the United States of America,or any agency thereof,with any person or organization. B. Under any Medical Payments Coverage,or under any Supplementary Payments or Claims Expenses provision relating to first aid,to expenses incurred with respect Bodily Injury resulting from the Hazardous Properties of Nuclear Material and arising out of the operation of a Nuclear Facility by any person or organization. C. Under any Liability Coverage,to Bodily Injury or Property Damage resulting from the Hazardous Properties of Nuclear Material;if (1) the Nuclear Material: (a)is at any Nuclear Facility owned by,or operated by or operated on behalf of any Insured or(b)has been discharged or dispersed therefrom; (2) the Nuclear Material is contained in Spent Fuel or Waste at any time possessed,handled,used, processed,stored,transported or disposed of by or on behalf of an Insured;or 1 1111 HCPL-2038(Ed.11/09) DocuSign Envelope ID:656DF690-72BC-42BC-9E47-7038084D8FFA . . ib ert ok €nter nazi nal ua(krc+,rkm. Healthcare Professional Liability (3) the Bodily Injury or Property Damage arises out of the furnishing by an Insured of services, materials,parts or equipment in connection with the planning,construction,maintenance,operation or use of any Nuclear Facility,but if such facility is located within the United States of America,its territories or possession or Canada,this exclusion(3)applies only to Property Damage to such Nuclear Facility and any property thereof. II. As used in this endorsement: "Hazardous Properties"include radioactive,toxic or explosive properties; "Nuclear Material"means Source Material,Special Nuclear Material or By-product Material; "Source Material" "Special Nuclear Material"and"By-product Material"have the meanings given them in the Atomic Energy Act of 1954 or in any law amendatory thereof; "Spent Fuel"means any fuel element or fuel component,solid or liquid,which has been used or exposed to radiation in a Nuclear Reactor; "Waste"means any waste material: (a) containing By-product Material other than the tailings or Wastes produced by the extraction or concentration of uranium or thorium from any ore processed primary for its source material content;and (b) resulting from the operation by any person or organization of any Nuclear Facility included under the first two paragraphs of the definition of Nuclear Facility; "Nuclear Facility"means: (a) any Nuclear Reactor; (b) any equipment or device designed or used for(1) separating the isotopes of uranium or plutonium,(2) processing or utilizing Spent Fuel,or(3)handling,processing or packaging Waste; (c) any equipment or device used for the processing,fabricating or alloying of Special Nuclear Material if at any time the total amount of such material in the custody of the Insured at the premises where such equipment or device is located consists of or contains more than 25 grams of plutonium or uranium 233 or any combination thereof,or more than 250 grams of uranium 235; (d) any structure,basis,excavation,premises or place prepared or used for the storage of disposal of Waste,and includes the site on which any of the foregoing is located,all operations conducted on such site and all premises used for such operations; "Nuclear Reactor"means any apparatus designed or used to sustain nuclear fission in self-supporting chain reaction or to contains critical mass of fissionable material; "Property Damage"includes all forms of radioactive contamination of property. 2 Ell HCPL-2038(Ed.11/09) DocuSign Envelope ID:656DF690-72BC-42BC-9E47-7038084D8FFA � �. liberty €aaternatitAnal Ua d r4+,ree.erb Healthcare Professional Liability New York - It is agreed that the provisions of the "Nuclear Energy Liability Exclusion Endorsement-Board Form" printed above, do not apply in New York with respect to any Non-Owned Auto Liability Coverage afforded by this policy. ALL OTHER"PERMS AND CONDITIONS OF THE POLICY REIN UNCHANGED. 3 Ell HCPL-2038(Ed.11/09) DocuSign Envelope ID:656DF690-72BC-42BC-9E47-7038084D8FFA liberty p intrrsaaticoss%1 Ua d r4+.ra ers- Healthcare Professional Liability LIBERTY INSURANCE UNDERWRITERS INC. (A Stock Insurance Company,hereinafter the"Company") ENDORSEMENT NO. [ ] Named Insured: Lorraine Lewis Policy Number: AH X-102357006 Effective Date: 06/01/2017 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NORTH CAROLINA AMENDATORY ENDORSEMENT I. In consideration of the premium paid,it is hereby agreed and understood that,Part I.,COVERAGE,of the above referenced policy is hereby deleted in its entirety and replaced with the following: I. COVERAGE The Company will pay on behalf of the Insured all sums which the Insured shall become legally obligated to pay as Damages for Claims first made against the Insured and reported to the Company during the Policy Period or Extended Reporting Period, if applicable, as a result of Bodily Injury, Property Damage or Personal Injury caused by an Incident,provided always that such Incident happens: A. on or after the policy effective date shown on the Declarations;or B. on or after the effective date of the earliest Claims-Made Policy issued by the Company of which this policy is a renewal;or C. at any time prior to the policy effective date shown on the Declarations if: 1. such Incident happens on or subsequent to the"Prior Acts Date"on the Declarations;and 2. no Insured knew or could reasonably foreseen that such Incident might be expected to be the basis of a Claim or Suit on the effective date of this policy or the first Claims-Made Policy issued by the Company to which this policy is a renewal,whichever is earlier. The Company will pay on behalf of the Insured all sums which the Insured shall become legally obligated to pay as Damages to which this insurance applies and the Company shall have the right and duty to defend any Suit against the Insured seeking Damages on account of such Bodily Injury, Property Damage or Personal Injury,even if any of the allegations of the Suit are groundless,false or fraudulent,but the Company shall not be obligated to pay any Claim or judgment after the applicable limit of the Company's liability has been exhausted by payment of judgments or settlements. The Company,at its option,shall select and assign defense counsel;however,the Named Insured may engage additional counsel, solely at their expense, to associate in their defense of any Claim covered hereunder. Claim Expenses incurred by the Company shall be paid in addition to the applicable Limit of Liability. The Company shall also have the right to investigate any Claim and/or negotiate the settlement thereof,as it deems 1 4 HCPL-2026-9000-NC (Ed.04/10) DocuSign Envelope ID:656DF690-72BC-42BC-9E47-7038084D8FFA liberty pik haatrrnatit41%1 U (kr4+.ra ers- Healthcare Professional Liability expedient, but the Company shall not commit the Named Insured to any settlement without their written consent. If the Named Insured refuses to consent to any settlement recommended in writing by the Company and elects to contest the Claim or continue any legal proceedings in connection with such Claim, then the Company shall be relieved of any further duty to defend the Claim,and the liability of the Company for Damages and Claim Expenses shall not exceed the amount for which the Claim could have been settled as well as the Claim Expenses incurred by the Company or with the Company's consent up to the date of refusal. The Insured shall not assume any obligations,incur any costs,charges,or expenses or enter into any settlement without the Company's written consent. II. In addition, it is hereby agreed and understood that, Part III., LIMIIT OF LIABILITY, of the above referenced policy is hereby deleted in its entirety and replaced with the following: III. LIVIIT OF LIABILITY Regardless of the number of Insureds under this insurance,the number of persons and/or organizations who sustain Bodily Injury, Property Damage and/or Personal Injury or the number of Claims made or Suits brought,the Company's liability is limited as follows: A. The Limit of Liability stated in the Declarations as applicable to "each Incident"is the total limit of the Company's liability for all Damages for each Incident covered by the policy, including any Extended Reporting Period. All Claims arising from the same or related Incident shall be considered a single Claim for the purpose of this insurance and shall be subject to the same Limit of Liability. B. The Limit of Liability stated in the Declarations as "Aggregate" is, subject to the above provisions involving "each Incident", the total limit of the Company's liability under this policy, including any Extended Reporting Period,for all Damages. C. However, and notwithstanding the foregoing,if a Supplemental Extended Reporting Period is purchased wherein the Limits of Liability for the Supplemental Extended Reporting Period are equal to and in addition to the Limits of Liability for the Policy Period: 1. The Limit of Liability stated in the Declarations as applicable to "each Incident"is the total limit of the Company's liability for all Damages for each Incident covered by the policy and resulting from a Claim first made during the Policy Period. All Claims arising from the same or related Incident shall be considered a single Claim for the purpose of this insurance and shall be subject to the same Limit of Liability. 2. The Limit of Liability stated in the Declarations as applicable to "each Incident"is the total limit of the Company's liability for all Damages for each Incident covered by the policy and resulting from a Claim first made during the Supplemental Extended Reporting Period. All Claims arising from the same or related Incident shall be considered a single Claim for the purpose of this insurance and shall be subject to the same Limit of Liability. 3. The Limit of Liability stated in the Declarations as "Aggregate" is, subject to the above provisions involving"each Incident",the total limit of the Company's liability under this policy for all Damage and resulting from all Claims first made during the Policy Period. 4. The Limit of Liability stated in the Declarations as "Aggregate" is, subject to the above provisions involving"each Incident",the total limit of the Company's liability under this policy for all Damage and resulting from a Claim first made during the Supplemental Extended Reporting Period. 4 HCPL-2026-9000-NC (Ed.04/10) DocuSign Envelope ID:656DF690-72BC-42BC-9E47-7038084D8FFA 11r liberty international Ua rkr4'rherb Healthcare Professional Liability III. In addition,it is hereby agreed and understood that,Part X. H., CONDITIONS,of the above referenced policy is hereby deleted in its entirety and replaced with the following: H. CANCELLATION This insurance may be cancelled on the customary short rate basis by the Named Insured at any time by written notice or by surrender of this insurance to the Company or its authorized representative and the Company shall refund the paid premium less the earned portion thereof within thirty(30) days of the latter of the effective date of cancellation or the date of delivery of the Insured's notice of intent to cancel. This insurance may also be cancelled, with or without the return or tender of the unearned premium, by the Company or by its authorized representative on its behalf, by sending to the Named Insured, by first-class registered or certified mail, at the Named Insured's address last known to the Company or its authorized agent, not less than ninety (90) days written notice stating the specific reason for such cancellation and when the cancellation shall be effective. In such case the Company shall refund the paid premium less the earned portion thereof within ten (10) business days after the effective date of cancellation, subject always to the retention by the Company of any minimum premium stipulated herein(or proportion thereof previously agreed upon)in the event of cancellation either by the Company or the Named Insured. In case of nonpayment of premium,only thirty(30)days written notice of cancellation must be given by the Company. A copy of such notice shall also be sent to the Named Insured's producer,if any. If this policy has been in effect for less than sixty (60) days and is not a renewal of a policy issued by the Company,this policy may be cancelled by the Company for any reason. If this policy has been in effect for sixty(60) days or more or is a renewal of a policy issued by the Company, cancellation by the Company shall only be effective if based on one or more of the following reasons: 1. nonpayment of premium; 2. any act or omission by any Insured or any Insured's representative that constitutes a material misrepresentation or a nondisclosure of a material fact in obtaining this policy, continuing this policy, or presenting a Claim under this policy; 3. any increased hazard or material change in the risk assumed that could not have been reasonably contemplated by the Company and an Insured at the time of the assumption of any risk insured under this policy; 4. any substantial breach of any contractual duty,condition,or warranty that materially affects the insurability of any risk insured under this policy; 5. any fraudulent act against the Company by any Insured or any Insured's representative, that materially affects the insurability of any risk insured under this policy; 6. Any willful failure by any Insured or any Insured's representative,to institute,after written notice by the Company, any reasonable loss control measure that materially affects the insurability of any risk insured under this policy; 7. any loss of or any substantial change in,the applicable reinsurance; 8. any Insured's conviction of a crime arising out of any act that materially affects the insurability of the risk; or 9. a determination by the North Carolina Insurance Commissioner that the continuation of the policy would place the Company in violation of any North Carolina law. 1V. In addition,it is hereby agreed and understood that Part N. I., CONDITIONS, of the above referenced policy is hereby amended to include the following: A copy of such notice shall also be provided to the Named Insured's producer. 4 HCPL-2026-9000-NC (Ed.04/10) DocuSign Envelope ID:656DF690-72BC-42BC-9E47-7038084D8FFA ` liberty international Ua rkr4+rherb Healthcare Professional Liability However,and notwithstanding the foregoing,notice shall not be required if: 1. the Named Insured has obtained replacement coverage; 2. the Named Insured has requested or agreed to the nonrenewal;or 3. the Named Insured has agreed to obtain replacement coverage. V. In addition,it is hereby agreed and understood that the last paragraph of Part X.J.,CONDITIONS,of the above referenced policy is hereby amended by the addition of the following: However,and notwithstanding the foregoing,the Named Insured shall have the right to purchase a Supplemental Extended Reporting Period wherein the Limits of Liability are equal to and in addition to the Limits of Liability as set forth in the Declarations and as described in Part III.of this policy. Within forty-five (45) days after the mailing or delivery of a written request from the Named Insured, the Company shall mail or deliver the following loss information covering a three(3)year period: 1. aggregate information on total closed Claims,including date and description of Incidents and any paid losses; 2. aggregate information on total open Claims,including date and description of Incidents and amounts of any payments;and 3. information on notice of any Incident,including date and description of Incident. ALL OTHER"IERNIS,CONDITIONS AND EXCLUSIONS REAL-IN UNCHANGED. 4 HCPL-2026-9000-NC (Ed.04/10) DocuSign Envelope ID:656DF690-72BC-42BC-9E47-7038084D8FFA if* ; ;,11; , : Healthcare Professional Liability LIBERTY INSURANCE UNDERWRITERS INC. (1 Stock Insurance Company,hereinafter the"Company") THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CHANGE ENDORSEMENT Members of the Federation In consideration of the premium charged for this policy,it is hereby understood and agreed that: 1. The definition of "Incident"is deleted in its entirety and replaced by: "Incident"means any acts or omission in the rendering or failure to render professional services to a patient or client by the Insured,or by any person for whom the Insured is legally responsible,in the professional occupation shown in the Declarations. "Incident"shall include services by the Insured as a member of a formal accreditation or similar professional board or committee of a hospital or professional society in the practice of the Insured's professional occupations as stated in the Declarations. "Incident"shall also mean any accident,including continuous or repeated exposure to substantially the same general conditions,which causes Bodily Injury or Property Damage. "Incident"specifically includes the following extension: Contractual Liability: Bodily Injury or Property Damage resulting from any incidental contract relating to the conduct of the Person Insured's business,except if such injury or damage occurred prior to the execution of the incidental contract: 1. Personal Injury and Advertising Liability:personal injury or advertising injury sustained by any person or organization,which arises out of the conduct of the Person's Insured's business during the policy period: 2. Host Liquor Liability: Bodily Injury or Property Damage arising out of the giving or serving of alcoholic beverages at functions incidental to the Person Insured's business;provided the Person Insured is not engaged in the business of manufacturing,distributing,selling,or serving of alcoholic beverages; 3. Fire Legal Liability;property damage or structures or portions thereof rented to or leased to the Person Insured,including fixtures permanently attached thereto,if such Property Insured,including fixtures permanently attached thereto,if such Property Damage arises out of fire. Solely as respects Fire Legal Liability coverage,all the exclusions of the policy,other than exclusion c.,g.are deleted;and the Nuclear Energy Liability Exclusion(Broad Form)are deleted. 2. Section 1.;Coverage,is deleted in its entirety and replaced by: I. COVERAGE The Company will pay on behalf of the Insured all sums which the Insured shall become legally obligated to pay as Damages for Claims first made against the Insured and reported to 8 HCPL-8001 (Ed.11/09) DocuSign Envelope ID:656DF690-72BC-42BC-9E47-7038084D8FFA If* ; ;,11; , : Healthcare Professional Liability the Company during the Policy Period as a result of Bodily Injury or Property Damage caused by an Incident. Provided always that such Incident happens: (a) On or after the policy effective date shown on the Declarations;or (b) At any time prior to the policy effective date shown on the Declarations if: (1) such Incident happens on or subsequent to the latter of October 1,1988 or membership inception;and (2) No Insured knew or could have reasonably foreseen that such incident might be expected to be the basis of a Claim or suit on the effective date of the first policy insured by the Company to the Insured. The company shall have the right and duty to defend any suit against the Insured seeking Damages to which this insurance applies even if any of the allegations of the suit are groundless,false or fraudulent. The Company may make such investigation and settlement of any claim or suit as it deems expedient. Claims Expenses incurred by the Company shall be obligated to pay Damages or Claims Expenses or to defend,or continue to defend,any suit after the applicable limit of the company's liability has been exhausted by payments of judgment of settlements. 3. Section II.,PERSONS INSURED,is deleted in its entirety and replaced by: II. PERSONS INSURED Each of the following is a"Person Insured"as defined by the policy. A. The Named Insured stated in the Declarations,but only as respects liability arising from the sole negligence of an insured listed in B.or C.below. B. Any sole proprietorship,partnership or other organization owned and operated by one or more individual registered members of the Named Insured. C. Any individual registered member of the Named Insured who is not a sole proprietor,partner, executive officer,director,stockholder or employee of any entity listed in B.above 4. The definition of"Insured"is deleted in its entirety and replace by: "Insured"shall mean any person or organization specified as a Person Insured in Section II of this policy. Insured shall also mean: (a) Any current or former employee of the Person Insured; 8 HCPL-8001 (Ed.11/09) DocuSign Envelope ID:656DF690-72BC-42BC-9E47-7038084D8FFA I ilk Healthcare Professional Liability (b) Any executive officer,director or stockholder of the Person Insured;but only as respects the liability of the Person Insured for the incidents which occur while such Insureds are acting on behalf of the Persons Insured and within the scope of their duties as such. 5. Section III.,LIMIT OF LIABILITY,is deleted in its entirety and replace by: III. LIMIT OF LIABILITY (a) Regardless of the number in Insureds under this insurance,the number of persons who sustained Bodily Injury and/or Property Damage or the number of Claims made or suits brought,the limit of liability stated in the Declarations as applicable to"each incident"is the limit of the company's liability for all Damages for each Incident covered by the policy,including any Extended Reporting Period. All Claims arising from the same or related Incident shall be considered a single Claim for the purpose of this insurance and shall be subject to the same limit of liability. (b) The limit of liability stated in the Declarations as"aggregate"is,subject to the above provision respecting"each Incident",the total limit of the Company's liability under this policy,including any Extended Reporting Period,for all Damages.The aggregate limit of liability shall apply separately to each"Person Insured". (c) The purchase of any Extended Reporting Period option shall not increase the limit of liability available under this insurance. However,the Deductible,as stated in Item#4 of the Declarations, shall be reinstated with the purchase of any Extended Reporting Period Option. 6. The"Definitions"section of the policy is amended by the addition of: "Advertising Injury"means injury arising out of an offense committed during the policy period occurring in the course of the Person Insured's advertising activities,if such injury arises out to libel, slander,defamation,violation of right of privacy,piracy,unfair competition,or infringement of copyright,title or slogan: "Automobile"means a land or motor vehicle,trailer of semitrailer designed for travel on public roads(including any machinery or apparatus attached thereto),but does not include mobile equipment; "Collapse Hazard"includes"Structural Property Damage"as defined herein and property damage to any other property at any time resulting therefrom.Structural Property Damage means the collapse of or structural injury to any building or structure due to(1)grading of land,excavating, borrowing,filling,back-filling,tunneling,pile driving,cofferdam work or caisson work,or(2)moving, shoring,underpinning,raising or demolition of any building or structure or removal or rebuilding of any structural support thereof. The Collapse Hazard does not include property damage(1)arising out of operations performed for any Person Insured by independent contractors of(2)included within the Completed Operations Hazard of the Underground Property Damage hazard,or(3) for which liability is assumed by the insured under an Incidental Contract: "Completed Operations Hazard"includes Bodily Injury and Property Damage arising out of operations or reliance upon a representation or warranty made at any time with respect thereto,but only if the Bodily Injury or Property Damage occurs after such operations have been completed or abandoned and occurs away from premises owned or rented to any Persons Insured. "Operations" 8 HCPL-8001 (Ed.11/09) DocuSign Envelope ID:656DF690-72BC-42BC-9E47-7038084D8FFA I flAs. Healthcare Professional Liability includes materials,parts or equipment furnished in connection therewith. Operations shall be deemed completed at the earliest of the following time: (1) When all operations to be performed by or on behalf of any Person Insured under the contract have been completed. (2) When all operations to be performed by or on behalf of any Person Insured at the site of the operations have been completed,or (3) When the portion of the work of which the injury or damage arises has been put to its intended use by any person or organization other then another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. Operations which may require further service or maintenance work,or correction,repair or replacement because of any defect or deficiency,but which are otherwise complete,shall be deemed completed. The completed operations hazard does not include Bodily Injury or Property Damage arising out of: (1) operations in connection with the transportation of property,unless the Bodily Injury or Property Damage arises out of a condition in or on a vehicle created by the loading or unloading thereof, (2) the existence of tools,uninstalled equipment or abandoned or unused materials or (3) operations for which the classification stated in the policy or in the company's guidelines specifies "including completed operations": "Explosion Hazard"includes Property Damage arising out of blasting or explosion. The Explosion Hazard does not include Property Damage(1)arising out of the explosion of air or seam vessels,piping under pressure, prime movers,machinery or power transmitting equipment,or(2)arising out of operations performed for any Person Insured by the independent contractors,or(3)included with in the Completed Operations Hazard or the Underground Property Damage Hazard,or(4) for which liability is assumed by the Insured under an Incidental Contract; "Incidental Contract"means any oral or written contract or agreement relating to the conduct of the Person Insured's business,except as respect Fire Legal Liability coverage; "Mobile Equipment"means a land vehicle(including any machinery or apparatus attached thereto),whether or not self-propelled,(1)not subject to motor vehicle registration or(2)maintained for use exclusively on premises owned by or rented to the Person Insured,including the ways,immediately adjoining,or(3) designed for use principally off public roads,or(4)designed or maintained for the sole purpose of affording mobility to equipment of the following types forming an integral part of or permanently attached to such vehicle:power cranes,shovels, loaders,diggers and drills;concrete mixers(other than the mix-in-transit type); graders,scrappers,rollers and generators,including spraying welding and building cleaning equipment,and geophysical exploration and well servicing equipment; "Person Insured's Product"means goods or product manufactured by the Person Insured or by others trading under this name,including any container thereof; "Personal Injury"means: 8 HCPL-8001 (Ed.11/09) DocuSign Envelope ID:656DF690-72BC-42BC-9E47-7038084D8FFA Healthcare Professional Liability Group 1—false arrest,detention or imprisonment,or malicious prosecution; Group 2—the publication or utterance of a libel or slander or of other defamatory or disparaging material,or a publication or utterance in violation of an individual's right of privacy'except publications or utterance in the course of or related to advertising,broadcasting or telecasting activities conducted by or on behalf of any Person Insured; Group 3—wrongful entry or eviction or other invasion or the right of private occupancy; "Products Hazard"includes Bodily Injury and Property Damage arising out of the Person Insured's Products or reliance upon a representation or warranty made at any time with respect thereto,but only if the Bodily Injury or Property Damage occurs away from premises owned by or rented to any Person Insured and after physical possession of such products have been relinquished to others; "Suite"includes an arbitration proceeding to which the Insured is required to submit or to which the Insured has submitted with the companies consent. "Underground Property Damage"means Property Damage to wired,conduits,pipes,mains,sewers,tanks tunnels,any similar property,and any apparatus in connection therewith,beneath the surface of the ground or water,cause by an occurring during the use of mechanical equipment for the purpose of grading land,paving, excavating,drilling,burrowing,filling,back-filling or pile driving. The Underground Property Damage Hazard does not include Property Damage(1)arising out of operations performed for any Person Insured by independent contractors,or(2)included within the Completed Operations Hazard,or(3) for which liability is assumed by the Insured under an Incidental Contract. 7. The definition of Claim is deleted in its entirety and replaced by: "Claim"means a demand for money,or the filing of suit or institution of arbitration proceedings,naming the Insured and alleging a Bodily Injury or Property Damage as a result of an Incident. 8. Section K.of CONDITIONS,Extended Reporting Period Option,is deleted in its entirety and replaced by: 9. Extended Reporting Period Option: (a) Cancellation/Non-Renewal In case of cancellation or non-renewal of this policy by the Named Insured or the Company,for any reason other than non-payment of premium or deductible or failure to comply with the terms or conditions of this policy,the Named Insured shall have the right to have an endorsement issued extending the reporting period,for an additional premium of: (i) 90%of the full annual premium for this policy,to a period of twelve(12)months,or (ii) 135%of the full annual premium for this policy,to a period of twenty-four(24)months,or (iii) 150%of the full annual premium for this policy,to a period of thirty-six(36)months,or (iv) 175%of the full annual premium for this policy,to a period of sixty(60) months 8 HCPL-8001 (Ed.11/09) DocuSign Envelope ID:656DF690-72BC-42BC-9E47-7038084D8FFA I ilk Healthcare Professional Liability following the effective date of such cancellation or non-renewal in which to give written notice to the Company of Claims first made against the Insured during this Extended Reporting Period for any Incident occurring prior to the termination of the final Policy Period,subject to its terms,limitations,exclusions and conditions. This right shall terminate,however,unless written notice of such election together with the additional premiums received by the Company or its authorized agent from the Named Insured within thirty(30)days after the effective date of such cancellation or non-renewal. (b) At the commencement of any Extended Reporting Period options,the entire premium therefore shall be deemed earned,and in the event the Named Insured terminates the Extended Reporting Period before its term for any reason,the Company shall not be liable to return to the Insured any portion of the premium for the Extended Reporting Period The fact that the period during which Claims must be first made against the Insured under this policy is extended by virtue of any Extended Reporting Period option shall not in any way increase the limit of Liability of this policy.The limit of liability available under any Extended Reporting option shall be a part of,and not in addition to,the limit of liability available under the last policy or renewal certificate insured to the Named Insured. 10. The"EXCLUSIONS"section of the policy is amended by the addition of: Q. to Bodily Injury or Property Damage arising out of the ownership,maintenance,operation,use, loading or unloading of: (i) any watercraft owned or operated by or rented or loaned to any Insured,or (ii) any other watercraft operated by any person in the course of his employment by any Insured; but this exclusion does not apply to watercraft while ashore on premises owned by,rented to or controlled by any Person Insured; R. to Bodily Injury or Property Damage due to war,whether or not declared,civil war,insurrection, rebellion or revolution to any act or condition incident to any of the foregoing; S.to Bodily Injury or Property Damage for which the Insured or his employee may be held liable: (i) as a person or organization engaged in the business of manufacturing,distributing,selling or serving alcoholic beverages,or (ii) if not so engaged,as an owner lessor of premises used for such purposes,if such liability is imposed by,or because of the violation or,any statute,ordinance or regulation pertaining to the sale,gift,distribution or use of any alcoholic beverage,including the selling,serving or giving of any alcoholic beverage to a minor 8 HCPL-8001 (Ed.11/09) DocuSign Envelope ID:656DF690-72BC-42BC-9E47-7038084D8FFA Healthcare Professional Liability T. to Property Damage included within: (i) the Explosion Hazard, (ii) the Collapse Hazard, (iii) the Underground Property Damage Hazard; U. to any claim made by an employer against an Insured who is a salaried employee of such employer; V. Solely as respects Fire Legal Liability coverage,to liability assumed by the Insured under any contract or agreement. W. to Bodily Injury or Property Damage arising out of the ownership,maintenance,operation,use, loading or unloading of (i) any automobile or aircraft owned or operated by or rented or loaned to any Insured,or (ii) any other automobile or aircraft operated by any person in the course of this employment by an Insured; but this exclusion does not apply to the parking of an automobile on premises owned by,or rented to or controlled by an Person Insured or the ways immediately adjoining,if such automobile is not owned by or rented to any Insured; X. to Bodily Injury or Property Damage arising out of(1)the ownership,maintenance,operation,use loading or unloading of any mobile equipment while being used in any prearranged or organized racing, speed or demolition contest or in any stunting activity or in practice or preparation for any such contest or activity of(2)the operation or use of any snowmobile or trailer designed for use therewith, Y. to Bodily Injury or Property Damage arising out of and in the course of the transportation of mobile equipment by an automobile owned or operated by or rented or loaned to any Insured; Z. to property owned or occupied by or rented to the Insured,or to property held by the Insured for sale or entrusted to the Insured for storage or safekeeping; Vy. to loss of use of tangible property which has not been physically injured or destroyed resulting from: a. a delay in or lack of performance by or on behalf of any Insured or any contract or agreement,or b. the failure of any Persons Insured's Products or work performed by or on behalf of the Person Insured to meet with the level of performance,quality,fitness or durability warranted or represented by the Person Insured; but the exclusion does not apply to loss of use of tangible property resulting from the sudden and accidental physical injury to or destruction of the Person Insured's Products or work performed by or on behalf of the Person Insured after such products or work have been put use by any person or organization other than an Insured; BB. to Property Damage to the Person Insured's Product arising out of such products or any part of such products; 8 HCPL-8001 (Ed.11/09) DocuSign Envelope ID:656DF690-72BC-42BC-9E47-7038084D8FFA I flAs. Healthcare Professional Liability CC. to claims or suits brought for the withdrawal,inspection,repair,replacement,or loss or use of the Person Insured's Products or work completed by or for the Person Insured or of any property of which such products or work from a part,if such products,work or property are withdrawn from the market or from use because of any known or suspected defect or deficiency therein; DD. to Bodily Injury and Property Damage included within the Products Hazard or Completed Operations Hazard; EE. as respects Personal Injury and Advertising Injury Liability coverages: (i) to liability assumed by the Insured under any contract or agreement; (ii) to Personal Injury or Advertising Injury arising out of the willful violation of a penal statute or ordinance committed by or with the knowledge or consent of the Insured; (iii) to Personal Injury or Advertising Injury arising out of a publication or utterance of a libel or slander,or a publication or utterance in violation of an individual's right of privacy if the first injurious publication or utterance of the same or similar material by or on behalf on any Person Insured was made prior to the effective date of coverage under the policy. (iv) to Personal Injury or Advertising Injury arising out of libel or slander of the publication of utterance of defamatory or disparaging material concerning any person or organization or goods,products or services or in violation of an individual's right of privacy,made by or at the direction of the Insured with the knowledge of the falsity thereof; FF. to Advertising Injury arising out of: (1) failure of performance of contract,but this exclusion does not apply to the unauthorized appropriation of ideas based upon alleged breach of implied contract;or (ii) infringement of trademark,service mark or trade name,other than tides or slogans,by use thereof on or in connection with goods,products or services sold,offered for sale or advertised,or (iii) incorrect description or mistake in advertised price of goods products or service sold, offered for sale or advertised; GG. based on or arising out of the use of: (v) acupuncture;and/or (vi) the use of electric stimulation with a voltage in excess of 35 volts HH. as respect to Advertising Injury: a. to any Insured in the business of advertising,broadcasting,publishing,telecasting,or b. to any injury arising out of any act committed by the Insured with actual malice; ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. 8 HCPL-8001 (Ed.11/09) DocuSign Envelope ID:656DF690-72BC-42BC-9E47-7038084D8FFA e. i berty €rater nazi nal U rd rc+,ra ers> Healthcare Professional Liability LIBERTY INSURANCE UNDERWRITERS INC. (.Stock Insurance Company,hereinafter the"Company") THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COVERAGE EXTENSION UPON MEMBERSHIP TERMINATION ENDORSEMENT The premium for this endorsement is included in the premium shown on the Declarations unless a specific amount is shown here: Premium: $ In consideration of an additional premium of$ per member, each Insured shall be entitled, upon termination of active membership status,to an indefinite period of time following the effective date of such termination in which to give written notice to the Company of Claims first made against the Insured during this Reporting Period for an Incident occurring prior to the termination of their membership in the Federation subject to all other policy terms, conditions, limitation and exclusions. This Reporting Period shall terminate in the event that this policy is cancelled or non-renewed by the Named Insured or the Company. ALL OTHER lERNIS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. • 1 HCPL-8004(Ed. 11/09) DocuSign Envelope ID:656DF690-72BC-42BC-9E47-7038084D8FFA � �. berty €nternatiaonal U rd r4+sitars. Healthcare Professional Liability LIBERTY INSURANCE UNDERWRITERS INC. (.Stock Insurance Company,hereinafter the"Company") THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. INDIVIDUAL LIMIT REFLECTED ON CERTIFICATE ENDORSEMENT The each Incident/Aggregate Limits of Liability with respect to any Named Insured is shown on the individual Certificate of Insurance,which is attached to,and forms a part of the master policy. ALL OTHER PERMS AND CONDITIONS OF THE POLICY REIN UNCHANGED. • 1 HCPL-8005(Ed.11/09) DocuSign Envelope ID:656DF690-72BC-42BC-9E47-7038084D8FFA � �. -ry €aaterssatit on-al U rd r4+,raters. Healthcare Professional Liability LIBERTY INSURANCE UNDERWRITERS INC. (.Stock Insurance Company,hereinafter the"Company") THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ONE YEAR GUARANTEE COVERAGE ENDORSEMENT Notwithstanding anything in the policy to the contrary,in the event of any person or entity becomes an"INSURED" after the effective date of the master policy,coverage for such person or entity will continue for a period of twelve(12) months from the effective date of membership regardless of whether or not the policy is cancelled or non-renewed. ALL OTHER PERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. • 1 HCPL-8002(Ed.11/09) DocuSign Envelope ID:656DF690-72BC-42BC-9E47-7038084D8FFA 4 liberty international Untkrc'rherb PROFESSIONAL LIABILITY LIBERTY INSURANCE UNDERWRITERS INC. ('1 New York Stock Insurance Company,hereinafter the"Insurer") ENDORSEMENT NO. [ ] Effective Date: 06/01/2017 Policy Number: AHX-102357006 Issued To: Lorraine Lewis THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. U.S. ECONOMIC AND TRADE SANCTIONS ENDORSEMENT Whenever coverage provided by this policy would be in violation of any U.S.economic or trade sanctions such as,but not limited to,those sanctions administered and enforced by the U.S.Treasury Department's Office of Foreign Assets Control("OFAC"),such coverage shall be null and void. Similarly,any coverage relating to or referred to in any certificates or other evidences of insurance or any claim that would be in violation of U.S.economic or trade sanctions as described above shall also be null and void. 1111 OF AC 08/09 DocuSign Envelope ID:656DF690-72BC-42BC-9E47-7038084D8FFA liberty pik € ter natit:ial U rd r4+,rkerb Healthcare Professional Liability LIBERTY INSURANCE UNDERWRITERS INC. (.Stock Insurance Company,hereinafter the"Company") ENDORSEMENT NO. [ ] Effective Date: 06/01/2017 Policy Number: AHX-102357006 Issued To: Lorraine Lewis THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NAMED INSURED The Named Insured on the Master Policy Declarations,form HCPL-2030D is completed to read as follows: The coverage afforded under this policy is for individual members of the following Federations who are added to the policy via Certificate form HCPL-2026D: American Polarity Therapy Association The Trager Institute American Organization for Bodywork Therapies of Asia The Feldenkrais Guild International Somatic Movement Education and Therapy Association American Society of the Alexander Technique ALL OTHER PERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. 1 HCPL-8086 (Ed. 12/10)