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PROOF OF INSURANCE (2025 - 2025)HEALTHCARE PROVIDERS SERVICE 0HPS0 ORGANIZATION PURCHASING GROUP CNA Certificate of lfor ace OCCURRENCE PROFESSIONAL LIABILITY POLICY FORM Print Date: 8/15/2024 The application for the Policy and any and allsupplementary information, materials, and statements submitted therewith shall be maintained on file by us or our Program Administrator and will be deemed attached to and incorporated into the Policy as if physically attached. PRODUCER BRANCH PRIEPFIX POLICY NUMBER POLICY R20 m.. _P . 7P2 0 07/27/25 at 12:01 AM Standard 0733490406 Time Named Insured and Address: Program Adml _... m, _ Administered by .Tess: �. Hang -Ten Therapeutics LLC Healthcare Providers Service Organization 1839 Colby Ave Apt 2 1100 Virginia Drive, Suite 250 Los Angeles, CA 90025-5429 Fort Washington, PA 19034 1-888-288-3534 www.hpso.com McOCCI Specialty: Code: __......ce Provided by �........... � .... � ....... Occupational Therapist Firm _d _ 80721 casualty Company of Reading, Pennsylvania A51eNC Franklin Street Excludes Cosmetic Procedures Chicago, IL 60606 Professional Liability $ 1,000,000 each claim $ 3 000 000 aggregate ... _. . Voor proressionaf liability limits shown above lncWde the follow * Good Samaritan Liability * Malplacement Liability * Personal Injury Liability * Sexual Misconduct Included in the PL limit shown above subject to $ 25,000 aggregate sublimit Coverage Extensions ion License Prootf ect'" $ 25,000 per proceeding $ 25,000 aggregate Defendant Expense Benefit $ 1,000 per day limit $ 25,000 aggregate Deposition Representation $ 10,000 per deposition $ 10,000 aggregate Assault $ 25,000 per incident $ 25,000 aggregate Includes Workplace Violence Counseling Medical Payments $ 25,000 per person $ 100,000 aggregate First Aid $ 10,000 per incident $ 10,000 aggregate Damage to the Property of Others $ 10,000 per incident $ 10,000 aggregate Information Privacy (HIPAA) Fines and Penalties $ 25,000 per incident $ 25,000 aggregate Media Expense General Liab„i„Ity General Liability Fire & Water Legal Liability Personal Liability Total $ 508.00 _.M......._......,.......... Premium �..........$508.0__.. Base P 0 $ 25,000 per incident $ 25,000 aggregate $1,000,000 each claim / $3,000,000 aggregate Included in the GL limit shown above subject to $250,000 aggregate sublimit Excluded Policy Forms and Endorsements (Please see attached list of policy forms and endorsements) Chairman of the Board Secretary Keep this Certificate of Insurance in a safe place. It and proof of payment are your proof of coverage. There is no coverage in force unless the premium is paid in full. To activate your coverage, please remit premium in full by the effective date of this Certificate of Insurance. Coverage Change Date: Endorsement Date: Master Policy: 188711433 CNA93692 (11-2018) © Copyright CNA All Rights Reserved. POLICY FORMS & ENDORSEMENTS The following are the policy forms and endorsements that apply to your current professional liability policy. COMMON POLICY FORMS & ENDORSEMENTS FORM # G-121500-D (04-08) G-121501-C1 (07-01) CNA82011 (04-15) G-145184-A (06-03) G-147292-A (03-04) CNA81753 (03-15) CNA81758 (01-21) GSL13424 (05-09) GSL13425 (05-09) GSL15563 (02-10) GSL15564 (10-09) GSL15565 (03-10) GSL17101 (02-10) CNA80052 (09-14) CNA94164 (11-18) G-123846-D04 (07-01) CNA79575 (07-14) CNA89026 (05-17) CNA96096 (06-19) G-121504-C (07-01) G-123827-B (07-01)(02) G-123828-B (07-01) FORM NAME Common Policy Conditions Occurrence Policy Form - California Related Claims Endorsement Policyholder Notice - OFAC Compliance Notice Policyholder Notice - Silica, Mold & Asbestos Disclosure Coverage & Cap on Losses from Certified Acts Terrorism Notice - Offer of Terrorism Coverage & Disclosure of Premium Services to Animals Business Owner Coverage Extension Endorsement Information Privacy Coverage Endorsement HIPAA Fines, Penalties & Notification Costs Sexual Misconduct Sublimits of Liability Professional Liability & Sexual Misconduct Exclusion Healthcare Providers Professional Liability Assault Coverage Exclusion of Specified Activities Reuse of Parenteral Devices and Supplies Distribution or Recording of Material or Information in Violation of Law Exclusion Endorsement Amendment Definition of Claim Endorsement California Cancellation and Non -Renewal Exclusion of Cosmetic Procedures Media Expense Coverage Amended Definition of You and Yours General Liability Form Additional Insured General Liability Certificate Holder PLEASE REFER TO YOUR CERTIFICATE OF INSURANCE FOR THE POLICY FORMS & ENDORSEMENTS SPECIFIC TO YOUR STATE AND YOUR POLICY PERIOD. For NJ residents: The PLIGA surcharge shown on the Certificate of Insurance is the NJ Property & Liability Insurance Guaranty Association. For KY residents: The Surcharge shown on the Certificate of Insurance is the KY Firefighters and Law Enforcement Foundation Program Fund and the Local Tax is the KY Local Government Premium Tax. As required by 806 Ky. Admin Regs. 2:1-00, this Notice is to advise you that a surcharge has been applied to your insurance premium and is separately itemized on the Declarations page or billing instrument attached to your policy, as required KRS. §136.392. For WV residents: The surcharge shown on the Certificate of Insurance is the WV Premium Surcharge. For FL residents: Form #:CNA93692 (11-2018) Named Insured: Hang -Ten Therapeutics LLC Master Policy #: 188711433 Policy #: 0733490406 © Copyright CNA All Rights Reserved_ MOI 03-23 r ..mr,//<i,,.��,/��%///j/%%/�/a//�j//�//���L%ll/✓��/%/!G,�./r��,,.���„/1����.:_�,r./,r,.,,,./��.,��/r,r-.,,�/.1 r /-.,..,,,�r%.:.,/,,,.r./G,r„u,,,,..,:r-...,:,. ✓ ..,/r,,,/✓r../�.a/ COMPANY: INSURED: GEICO General Insurance Company I HANG -TEN THERAPEUTICS LLC One GEICO Boulevard 1839 COLBY AVENUE Fredericksburg, VA 22412 2 UNIT LOS ANGELES , CA 90025 1-866-509 9444 //,, IN; '"'",u:�;�wt,,,�, ���/l/.o...�l '.�/,�uv. �.,, �!!.. ����;��//////��r//iri�:,r;�, .,...�.•.r.�-i. a f:�...�,��ri..�lar ....,...,a� � ,r.,..._,„/// /r/,,,<� !.�;�;u,....�,/.,�.», �.rru�6��nr/:� . v.,. This memorandum is furnished to you as a matter of information for your convenience. It is not intended to reflect: all the terms and conditions or exclusions of such policies. This memorandum is not an insurance policy and does not amend, alter, or extend the coverage afforded by the listed policies. The insurance afforded by the listed policy is subject to all the terms exclusions and conditions of such policies TYPE OF INSURANCE POLICY EFF. DATE EXP. DATE LIMITS SHOWN ARE AS REQUESTED NUMBER COMMERCIAL ? COMBINED SIN ..... .... A.w,,,,,,,,_ .............. SINGLE LIMIT AUTOMOBILE LIABILITY (Ea. Accident ❑ ANY AUTO BODILY INJURY......... �,,$500 rv.. ,000l$100,000 ❑ ALL OWNED AUTOS (Per Person/ Per Accident) 9300099877-6 01 /02/2025 07/02/2025 ❑ HIRED AUTOS 0 SCHEDULED AUTOS PROPERTY DAMAGE 1$25,000 ❑ NON -OWNED AUTOS (Per accident) OTHER COVERAGES COMBINED SINGLE LIMIT ❑ANY AUTO (Ea. Accident) El ALL OWNED AUTOS UNINSURED MOTORISTS ❑ HIRED AUTOS (UMCSL) SCHEDULED AUTOS 9300099877-6 01/02/2025 07/02/2025 ❑ NON -OWNED AUTOS UNDERINSURED ❑ MOTORISTS (UIMCSL) , j UNINSURED MOTORISTS $30000/$ 60, 000 � (Per Person/ Per Accident) 1 UNDERINSURED MOTORISTS ( Accident) Per Person/ Per UNINSURED MOTORISTS PD (Per accident) PERSOENAL N (PL.. a ..:: ..—n.n,.,... INJURY"""""' ........_....... P) MED EXP Not Included ❑X COMPRE E NISIVE DEDUCE BALE $500 deductible j 20151VHONDAIC„ _ _„_ C R-V i ❑X COLLISION DEDUCTIBLE $500 deductible j ❑ FIRE, THEFT AND SPECIFIC CAUSES OF LOSS DEDUCTIBLE i N/A_.................... ....... ........ _ _., ❑ COMPREHENSIVE DEDUCTIBLE ❑ COLLISION DEDUCTIBLE J ❑ FIRE, THEFT AND SPECIFIC CAUSES OF LOSS DEDUCTIBLE ' ❑ N/A ACTIVE DRIVERS: Naomi Matanick MOI 03-23 WARM IS UNL NG: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE AWFUL AND SUBJECTS AN EMPLOYER TO CRIMINAL PENALTIES IVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), iITIONTO THE COST OF COMPENSATION, DAMAGES AS PROVIDED LABOR CODE § 3706, INTEREST, AND ATTORNEY'S FEES. y of perjury under the laws of California one of the following declarations: maintain a certificate of consent of self -insure for workers' compensation, issued by the Director is as provided 'for by Labor Code § 3700 for the performance of the work set forth the agreement egundo. C d 3700 for the performance iin workers' compensation insurance as required by Labor o e Sr agreement with the City of El Segundo is executed. My workers' compensation insurance Policy Number Expiration Date Phone # performance of the work set forth in the agreement with the City of El Segundo, I will not ly manner so as to become subject to the workers' compensation laws of California, and )ecome subject to the workers' compensation provisions of Labor Code § 3700 1 must f' �sions or the agreement will automatically become void. _ _ Date 6d�