Laserfiche WebLink
• <br /> CHICAGO INSURANCE COMPANY <br /> INTERSTATE Executive Offices Client # <br /> INSURANCE 55 E.MONROE STREET 545349 <br /> GROUP CHICAGO, ILLINOIS 60603 ti <br /> MEDICAL PROFESSIONAL LIABILITY OCCURRENCE INSURANCE POLICY <br /> Region Producer Issued Prior Certificate Number Purchasing Group Policy Number <br /> 23 0001614 04/10/08 AHL-1274734 44-2010129 <br /> Offered through Allied Health Purchasing Group Association <br /> SECTION I DECLARATIONS <br /> Item CERTIFICATE NUMBER: AHL 1274734 <br /> 1. Named Insured: ERGOFIT CONSULTING INC <br /> 2. Mailing Address: CIO 5231 SW STEVENS ST.#B <br /> SEATTLE, WA 98116 <br /> 3. Policy Period: From: 04/24/2008 To: 04/24/2009 <br /> 12:01 A.M. Standard Time At Location of Designated Premises <br /> 4. Business or Profession: Affiliation: AMN. OCCUPATIONAL THERAPY ASSOCIATION <br /> OCCUPATIONAL TH1 RAPIST <br /> S/E MORE THAN 20 HOURS A WEEK <br /> 5. The Named Insured is a(n): ❑ Partnership Corporation ❑ Individual <br /> CI Sole Proprietor (with employees) ❑ Other: Organization <br /> This policy is made and accepted subject to the printed conditions of this policy together with the provisions, stipulations <br /> and agreements contained in the following forms(s) or endorsements(s): <br /> PLE-2087(04/00), PLJ-2037(05/98), PON-2003, PLE-8003(02/88) <br /> SECTION II <br /> Item COVERAGE Premium <br /> A. Professional Liability ® $440.00 <br /> B. General Liability ® $134.00 <br /> Endorsements IRS $176.00 <br /> TOTAL: $750.00 <br /> LIMITS OF LIABILITY <br /> $2,000,000 each Incident and $ 4,000,000 Aggregate <br /> each Occurrence <br /> SECTION III <br /> SUPPLEMENTARY PAYMENTS <br /> A. First Party Assault <br /> B. Licensing Board Reimbursement <br /> C. Wage Loss and Expense <br /> D. Deposition Expense <br /> E. First Aid Reimbursement <br /> Representative Agent or Broker <br /> MARSH Affinity Group Services <br /> a service of SEABURY&SMITH J <br /> 1440 RENAISSANCE DRIVE <br /> PARK RIDGE, IL 60068 <br /> 1-800-503-9230 <br /> PLP-2037 (05/98) <br /> PLP-2337 (PRNT) INSURED COPY <br />