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PROOF OF INSURANCE (2025)HEALTHCARE PROVIDERS SERVICE 0HPS0 ORGANIZATION PURCHASING GROUP CAfA Certificate of Jh5urauce 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 BRAN 018098 9/ CH I PREFIX_ �-- - HPG Named Insured and Address: Hang -Ten Therapeutics LLC 1839 Colby Ave Apt 2 Los Angeles, CA 90025-5429 Medical POLICY NUMBER J POLICY PERIOD 0733490406 J Front: 07/27/24 to 07/27/25 at 12:01 AM Standard Time m Administered Healthcare Providers Service Organization 1100 Virginia Drive, Suite 250 Fort Washington, PA 19034 1-888-288-3534 www.hpso.com Code: Insurance Provided by: Occupational Therapist Firm 80721 Excludes Cosmetic Procedures American Casualty Company of Reading, Pennsylvania 151 N. Franklin Street Chicago, IL 60606 Professional Liability $ 1,000 000 each claim $ 3,000,000 aggregate ....... Your professional liability limits shown above include the following: * Good Samaritan Liability * Malplacement Liability * Personal Injury Liability * Sexual Misconduct Included in the PL limit shown above subject to $ 25,000 aggregate sublimit arage Extensions m License Protection $mm25,000 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 General Liability Fire & Water Legal Liability Personal Liability Total $ 508.00 m Base Premium $508m8..._..00 $ 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) 5" 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) 0 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. 2:100, 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.