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PROOF OF INSURANCE (2021) CLOSEDACCORD® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 3/16/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER The Graham Company The Graham Building 1 Penn Square West CONTACT NAME: Concentra Unit PHONE FAX A/C No Ext: 215-567-6300 A/C,No:215-405-2694 ADDE-MRESS: Concentra_Unit@grahamco.com INSURER(S) AFFORDING COVERAGE NAIC# Philadelphia PA 19102- INSURERA: Columbia Casualty Company 31127 INSURED CONCGRO-01 Occupational Health Centers of California, A Medical Corporation d/b/a Concentra, Inc. INSURERB: Liberty Mutual Fire Ins. Co. 23035 INSURERC: Liberty Insurance Corporation 42404 INSURERD: Liberty Mutual Insurance Group 23043 4714 Gettysburg Rd. Mechanicsburg PA 17055 INSURERE: American Guarantee & Liability Ins. Co. 26247 INSURERF: Allied World Assurance Company, AG COVERAGES CERTIFICATE NUMBER: 1665493508 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y HAZ4032244581-5 10/1/2020 10/1/2021 EACH OCCURRENCE $1,000,000 CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 500,000 X MED EXP (Any one person) $ 10,000 Professional Lia X $1M Claim/$3M Ag PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 PRO- POLICY JECT ❑ LOC X PRODUCTS - COMP/OP AGG $ 3,000,000 $ OTHER: B AUTOMOBILE LIABILITY Y Y AS2-631-510199-320 10/1/2020 10/1/2021 COMBINED SINGLE LIMIT Ea accident $2,000,000 X BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY A X UMBRELLALIAB X OCCUR Y Y HMC4032235752 10/1/2020 10/1/2021 EACH OCCURRENCE $9,000,000 AGGREGATE $ 10,000,000 EXCESS LAB CLAIMS -MADE DED X RETENTION $ $ G D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N Y WA7-63D-510199-350 WC5-631-510199-360 (WI) 10/1/2020 10/1/2020 10/1/2021 10/1/2021 X PER OTH- STATUTE1 ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICE R/M EMBER EXCLUDED? ❑ N/A E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 E Property ZMDO119116-05 10/1/2020 10/1/2021 SEE BELOW F Excess Liability CO23701-006 10/1/2020 10/1/2021 $10M Each Occurrence $10M Aggregate DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) UMBRELLA LIABILITY COVERAGE includes Excess General Liability on an Occurrence Basis and Excess Professional Liability on a Claims Made Basis. Both Coverages are excess of a $3,000,000 Self -Insured Retention each Occurrence/Claim subject to a $16,000,000 Aggregate. PROFESSIONAL LIABILITY COVERAGE includes Case Management Services including the rendering of case management or utilization review performed by insured for others. INDIANA PHYSICIAN PROFESSIONAL LIABILITY COVERAGE - Continental Casualty Company - Policy #HAZ 4032244595-6; Effective 10/1/2020-10/1/2021 - $400,000 Each Medical Incident/$1,200,000 Aggregate Per Insured or Surgeon See Attached... CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo ACCORDANCE WITH THE POLICY PROVISIONS. ATTN: David Serrano Director of Human Resources 350 Main Street El Segundo CA 90245 AUTHORIZED REPRESENTATIVE @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CONCGRO-01 LOC #: AGENCY The Graham Company POLICY NUMBER CARRIER ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE NAIC CODE NAMED INSURED Occupational Health Centers of California, A Medical Corporation d/b/a Concentra, Inc. 4714 Gettysburg Rd. Mechanicsburg PA 17055 EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Page 1 of 1 KANSAS PHYSICIAN PROFESSIONAL LIABILITY COVERAGE - Continental Casualty Company - Policy #HAZ 4032244600-6; Effective 10/1/2020-10/1/2021 - $200,000 Each Medical Incident/$600,000 Aggregate Per Insured or Surgeon LOUISIANA PHYSICIAN PROFESSIONAL LIABILITY COVERAGE - Columbia Casualty Company - Policy #HAZ 4032244614-6; Effective 10/1/2020-10/1/2021 - $100,000 Each Medical Incident/$300,000 Aggregate Per Insured or Surgeon NEBRASKA PHYSICIAN PROFESSIONAL LIABILITY COVERAGE - Columbia Casualty Company - Policy #HAZ 4032244628-6; Effective 10/1/2020-10/1/2021 - $500,000 Each Medical Incident/$1,000,000 Aggregate Per Insured or Surgeon PENNSYLVANIA PHYSICIAN PROFESSIONAL LIABILITY COVERAGE - Columbia Casualty Company - Policy #HAZ 4032244631-6; 10/1/2020-10/1/2021 - $500,000 Each Medical Incident/$1,500,000 Aggregate Per Insured or Surgeon WISCONSIN PHYSICIAN PROFESSIONAL LIABILITY COVERAGE - Continental Casualty Company - Policy #HAZ 4032244659-6; 10/1/2020-10/1/2021 - $1,000,000 Each Medical Incident/$3,000,000 Aggregate Per Insured or Surgeon PROPERTY COVERAGE: Risk of Physical Loss or Damage to Covered Property subject to policy terms and conditions KERS COMPENSATION - Occupational Health Centers of California, A Medical Corporation - Liberty Mutual Insurance Corp. - Policy i-63D-510199-310; Effective: 10/1/2020-10/1/2021 WORKERS COMPENSATION - Occupational Health Centers of Southwest, P.A. - Liberty Insurance Corp. - Policy #WA7-63D-510199-400; Effective: 10/1 /2020-10/1 /2021 WORKERS COMPENSATION - Occupational Health Centers of Southwest, P.A. - Liberty Mutual Insurance Corp. - Policy #WC5-631-510199-250 (WI); Effective: 10/1 /2020-10/1 /2021 �] ► IG1 ��ON] :7 :1 � :i.YK�] di I » ► 69G� � [�] ► � li] � [9 I �91 C of Arkansas — Liberty Insurance Corp. - Policy #WC7-631-510199-280; Effective: 10/1 /2020-10/1/2021 C of Southwest (AZ/UT) — Liberty Mutual Fire Insurance Company - Policy #WC2-631-510199-240; Effective: 10/1/2020-10/1/2021 C of Delaware — Liberty Mutual Fire Insurance Company - Policy #WC2-631-510199-330; Effective: 10/1/2020-10/1/2021 C of Georgia/Hawaii — Liberty Mutual Fire Insurance Company - Policy #WC2-631-510199-380; Effective: 10/1/2020-10/1/2021 C of Illinois — Liberty Mutual Fire Insurance Company - Policy #WC2-631-510199-410; Effective: 10/1 /2020-10/1 /2021 C of Louisiana — Liberty Mutual Fire Insurance Company - Policy #WC2-631-510199-290; Effective: 10/1/2020-10/1/2021 C of Michigan — Liberty Mutual Fire Insurance Company - Policy #WC2-631-510199-270; Effective: 10/1/2020-10/1/2021 C of Nebraska — Liberty Mutual Fire Insurance Company - Policy #WC2-631-510199-370; Effective: 10/1/2020-10/1/2021 C of New Jersey — Liberty Mutual Fire Insurance Company - Policy #WC2-631-510199-260; Effective: 10/1/2020-10/1/2021 C of North Carolina — Liberty Insurance Corp. - Policy #WC7-631-510199-340; Effective: 10/1/2020-10/1/2021 C of Southwest (KS) — Liberty Mutual Fire Insurance Company - Policy #WC2-631-510199-420; Effective: 10/1/2020-10/1/2021 !rapy Centers of Southwest I, PA (OR) - Liberty Mutual Fire Insurance Company - Policy #WC2-631-510199-390; Effective: 10/1/2020-10/1/2021 !rapy Centers of South Carolina, PA - Liberty Mutual Fire Insurance Company - Policy #WC2-631-510199-300; Effective: 10/1/2020-10/1/2021 C of Minnesota - Liberty Mutual Fire Insurance Company - Policy #WC2-631-510199-450; Effective: 10/1/2020-10/1/2021 C of Alaska - Liberty Mutual Fire Insurance Company - Policy #WC2-631-510199-440; Effective: 10/1/2020-10/1/2021 CYBER LIABILITY - National Union Fire Insurance Company of Pittsburgh, PA - Policy #01-823-21-33; Effective 9/25/2020-2021 - Limit: $10,000,000 Security and Privacy EXCESS CYBER LIABILITY - Endurance American Insurance Company - Policy #PEO 0201 0413; Effective: 9/25/2020-2021 - Limit: $10,000,000 Each Occu rre nce/Agg re gate Coverage is provided for all medical professionals currently or previously employed or contracted by the above Named Insured, but only for professional services performed for or on behalf of the above Named Insured. Re: 390 North Sepulveda Blvd, El Segundo, CA Re: OHC CA/CMC has an agreement under contract # 5856 to provide medical services to the employees of the named client. City of El Segundo, CA; its officials, employees and or agents are additional insureds on the above General Liability, Auto Liability and Umbrella Liability Policies if required by written contract. Coverage provided to the additional insureds shall apply on a Primary / Non -Contributory Basis on the above General Liability, Auto Liability and Umbrella Liability policies if required by written contract. Prior to loss, and if required by written contract, Waiver of Subrogation is provided on General Liability, Auto Liability, Umbrella Liability and Workers Compensation Policies for work performed under contract if permissible by state law. ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER:AS2-631-510199-320 COMMERCIAL AUTO CA20481013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. • • • This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. SCHEDULE Name Of Person(s) Or Organization(s): Any person or organization whom you have agreed in writing to add as an additional insured, but only to coverage and minimum limits of insurance required by the written agreement, and in no event to exceed either the scope of coverage or the limits of insurance provided in this policy. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II - Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I - Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 282 Policy Number: AS2-631-510199-320 COMMERCIAL AUTO CA 04"1013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respectto coverage provided by this endorsement, the provisionsof the Coverage Form apply unless modified by the endorsement. SCHEDULE Name(s) Of Person(s) Or Organization(s): Any person or organization for whom you perform work under a written contract if the contract requires you to obtain this agreement from us, but only if the contract is executed prior to the injury or damage occurring. Premium: $ INCL Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident' or the 'loss" under a contract with that person or organization. CA04441013 © Insurance Services Office, Inc., 2011 Page 1 of 1 249 CNA WAIVER OF RIGHTS OF RECOVERY APPLICABLE TO GENERAL LIABILITY COVERAGE FORM The changes set forth below are applicable only to the Commercial General Liability Coverage Form G- 145566-A, G-145567-A). The Healthcare Liability Policy Common Conditions (G-144102-A) are amended as set forth below: Condition XII., Transfer of Rights of Recovery is amended by the addition of the following: Solely within the scope of this endorsement as indicated above, we waive any right of recovery we may have against any person or organization that you have agreed with, in writing, prior to the date of loss, to waive your right to recover against because of payments we make under the Commercial General Liability Coverage Form for injury or damage arising out of your ongoing operations. This endorsement applies only to: All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. GSL6554XX (4-11) Page 1 Policy No: Endorsement No: Effective Date: Insured Name: Concentra Group Holdings Parent, LLC © CNA All Rights Reserved. HAZ 4032244581-5 10/01 /2020 POLICY NUMBER: HAZ 4032244581-5 COMMERCIAL GENERAL LIABILITY CG 20 26 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION TO WHOM OR TO WHICH YOU ARE REQUIRED TO PROVIDE ADDITIONAL INSURED STATUS IN A WRITTEN CONTRACT OR AGREEMENT EXECUTED PRIOR TO LOSS, EXCEPT WHERE SUCH CONTRACT OR AGREEMENT IS PROHIBITED BY LAW. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a c ontract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement applicable Limits of Declarations. shall not increase the Insurance shown in the CG 20 26 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 Pnl Iry NI IKARFR- HA7 4032244581-5 032244581-5 COMMERCIAL GENERAL LIABILITY CG 20 01 0413 THIS ENDORSEMENT CHANGES I Ht F'ULIGY. FLtASt READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an add itional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. CG 20 01 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2% of the California workers' compensation premium otherwise due on such remuneration. Schedule Additional premium is a percent of the California Manual Workers Compensation premium. Subject to a minimum premium charge of $ 250 Person or Organization Where required by contract or written agreement prior to loss and allowed by law. Issued by LM Insurance Corporation 27243 Job Description For attachment to Policy No. WA5-63D-510199-310 Effective Date Premium $ Issued to Occupational Health Centers of California, A Medical Corporation WC 04 03 06 Ed: 04/1984 Page 1 of 1 [Cy! \ \ ° / \ 0 s g m = > @ / a 2 E � E ) / _ s u \ \ \ E \ �& �_ § g } \ u ) E _ § § 7 0 \ _ \ & \ & m § u \ 0 ; § { � ƒ \ \ 2 q ƒ _ � 2 7 2 7 ƒ \ \ / _ \ 2 \ 2 /Ln / \/ u E\ E \{ 2 2 \ u E S E° u u cƒ = 2 c / { u { E { � ( ( LU / F- / ° \ } / $ 2 \ / \ / \ o \ '$ ) E E 7 E / E \ / / \ \ _ / E \ \ \ 7 § CL g f 2 m a a 3 a)ƒ \ E« t t t \ \ \ u 0\ 7 E 7 E 7 / 2 2 2 ƒ / o %' 3 3 )~ 3 3 3 ) 5 5 ; ° / / / b E > w E = 2 » / \ / /§\ u u u ± m E{ 2 E 2] m u \ \ \ k cr / I $ < / 0 0 / / / \ o o 0 2 2 2 2 4 �/ W/ § q \ E/ 0 0 0 o 0 0 o o a o± a 6 2 0= E< E; o a o o a a 0 0 0 0 0 0 0 0 0 0 •• o= o== 0 2 0= z 2 r 2 0 o o= o I o 0 2 0 0 0 0 E a a a a a \ 6 6= �.E o 0_ o%� 2 a a a a a / & \ & \ _ \ » & \ » 2 % \ ° z @ ® o Ln e o ��� 0� z� LU r_ LL�/ t I� E V)- 0 o / \ � m m @ e r � ¥ ¥ ¥ \E%%% 0§ / \ \ d d d / \ 0 / 0 \ \ \ \ 0 ' ® r < < < 0 o f // 4 4 4 § u ± < 2 k \ { \ ` ( z z » \ " 00 : 2 2 -0 \ I I m _ ) CL $ < / \ \ \ 3