CTR078643_COI.pdf

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

INSURER(S) AFFORDING COVERAGE

INSURER F :

INSURER E :

INSURER D :

INSURER C :

INSURER B :

INSURER A :

NAIC #

NAME:

CONTACT

(A/C, No):

FAX

E-MAIL

ADDRESS:

PRODUCER

(A/C, No, Ext):

PHONE

INSURED

REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES

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).

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.

OTHER:

(Per accident)

(Ea accident)

N / A

SUBR

WVD

ADDL

INSD

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.

$PROPERTY DAMAGE

BODILY INJURY (Per accident)

BODILY INJURY (Per person)

COMBINED SINGLE LIMIT

AUTOS ONLY

AUTOSAUTOS ONLY

NON-OWNED

SCHEDULEDOWNED

ANY AUTO

AUTOMOBILE LIABILITY

Y / N

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

OFFICER/MEMBER EXCLUDED?

(Mandatory in NH)

DESCRIPTION OF OPERATIONS below If yes, describe under

ANY PROPRIETOR/PARTNER/EXECUTIVE

E.L. DISEASE - POLICY LIMIT

E.L. DISEASE - EA EMPLOYEE

E.L. EACH ACCIDENT

ER

OTH-

STATUTE

PER

LIMITS(MM/DD/YYYY)

POLICY EXP

(MM/DD/YYYY)

POLICY EFF

POLICY NUMBERTYPE OF INSURANCELTR

INSR

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

EXCESS LIAB

UMBRELLA LIAB $EACH OCCURRENCE

$AGGREGATE

OCCUR

CLAIMS-MADE

DED RETENTION $

$PRODUCTS - COMP/OP AGG

$GENERAL AGGREGATE

$PERSONAL & ADV INJURY

$MED EXP (Any one person)

$EACH OCCURRENCE

DAMAGE TO RENTED

$PREMISES (Ea occurrence)

COMMERCIAL GENERAL LIABILITY

CLAIMS-MADE OCCUR

GEN'L AGGREGATE LIMIT APPLIES PER:

POLICY

PRO-

JECT LOC

CERTIFICATE OF LIABILITY INSURANCE

DATE (MM/DD/YYYY)

CANCELLATION

AUTHORIZED REPRESENTATIVE

ACORD 25 (2016/03)

© 1988-2015 ACORD CORPORATION. All rights reserved.

CERTIFICATE HOLDER

The ACORD name and logo are registered marks of ACORD

HIRED

AUTOS ONLY

4/1/2025

Brown & Brown Insurance Services, Inc 2800 N Central Ave, Suite 1100 PO Box 2800 Phoenix AZ 85004

Maria Rosaortega, ARM, CIC, CISR 602-664-7067

Maria.Rosaortega@bbrown.com

Argonaut Insurance Company 19801 00438864 CopperPoint Insurance Company 14216

Concentric Healthcare Solutions, LLC dba Concentric Healthcare Staffing 4250 N. Drinkwater Blvd #100 Scottsdale AZ 85251

Tokio Marine Specialty Insurance Company 23850 Arch Specialty Insurance Co 21199

1949222916

C X 2,000,000 X 100,000

10,000

2,000,000

4,000,000 X

X Stop Gap:

Y Y PPK2709885 4/1/2025 4/1/2026

4,000,000

OH, ND, WA, WY 1,000,000

C 1,000,000

X X

Y Y PPK2709885 4/1/2025 4/1/2026

C X 8,000,000 X

Y PUB918953 4/1/2025Y 4/1/2026

8,000,000 X 10,000

B A

X

N

Y WC1014656

WC 929218358184

4/1/2025 4/1/2025

4/1/2026 4/1/2026

1,000,000

1,000,000

1,000,000 C D C

Prof Liability (Medical E&O) Cyber Crime incl. 3rd Party

Y Y Y

Y PPK2709885

C-4M8G-041101-CYBER-2025

PPK2709885

4/1/2025 4/1/2025 4/1/2025

4/1/2026 4/1/2026 4/1/2026

See Below for Limits See Below for Limits See Below for Limits

Excess over Professional Limited to $6,000,000

Crime: Employee Dishonesty/Theft including Client Premises (3rd Party)(Policy #PPK2709885): Limit $3,000,000. Retention $25,000

Professional Liability - including Medical E&O: $2,000,000 each Claim/$4,000,000 aggregate. $25,000 deductible applies. Retro-date: 03/07/2005.

Indiana Professional Liability (Policy #PHPK2675954): $500,000 each Occurrence/$1,500,000 Aggregate. $10,000 deductible applies. Retro-date: 04/01/2023

See Attached...

Arizona State Hospital 2500 E Van Buren St Phoenix AZ 85008

ACORD 101 (2008/01)

The ACORD name and logo are registered marks of ACORD

© 2008 ACORD CORPORATION. All rights reserved.

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

FORM NUMBER: FORM TITLE:

ADDITIONAL REMARKS

ADDITIONAL REMARKS SCHEDULE Page of

AGENCY CUSTOMER ID:

LOC #:

AGENCY

CARRIER NAIC CODE

POLICY NUMBER

NAMED INSURED

EFFECTIVE DATE:

00438864

1 1

Brown & Brown Insurance Services, Inc Concentric Healthcare Solutions, LLC dba Concentric Healthcare Staffing 4250 N. Drinkwater Blvd #100 Scottsdale AZ 85251

25 CERTIFICATE OF LIABILITY INSURANCE

Sexual Misconduct Liability: $1,000,000 each Claim/$2,000,000 aggregate. $10,000 deductible applies. Retro-date: 03/07/2005

Cyber Liability: $5,000,000 each claim/$5,000,000 aggregate. $25,000 deductible applies. Retroactive Date – Full Prior Acts

Employment Practices Liability (Policy #PPK2709885) - including 3rd Party: $3,000,000 each Claim/$3,000,000 aggregate. $25,000 deductible applies.

Retro-date: 03/04/2006

Additional Insured applies on a blanket basis to the General Liability per attached from CG2026 0413; coverage is Primary & Non-contributory on a blanket basis per attached form PI-GL-005 0712 and blanket Waiver of Subrogation applies per attached form CG2404 0509. Additional Insured on a Primary and Non-Contributory basis with a Waiver of Subrogation applies on a blanket basis to the Professional Liability per attached form PI-TS-013 0512. Additional Insured applies on a blanket basis to the Auto Liability per attached form CA2048 0299 with blanket Waiver of Subrogation per attached form CA0444 0310, and Primary/Non-Contributory per form PI-CA-023 0719. Blanket Waiver of Subrogation applies to Workers' Compensation per attached form WC000313, WC430305. Blanket 30 Day Notice of Intent to Cancel applies per attached form PI-CANXAICH-002 0511. General Liability, Professional Liability and Auto Liability limits are not shared. Additional Insured applies to the Cyber Liability where required by written contract per policy. Umbrella underlying schedule includes: General Liability, Professional Liability; Employers' Liability; Employee Benefits Liability and Automobile Liability. Umbrella Policy follows form.

Separation of Insureds applied to the General Liability per attached page 13 of the CG0001 0413 and to the Professional Liability per attached page 10 of the PI-TS-003 1211. *VA Professional Liability limits apply with regards to § 8.01-581.15 of the Code of Virginia per attached form PI-MANU-1 0100.

WC Policy # WC1014656 applies to AZ, CA, CO, ID, IL, LA, MT, NV, OK, TX, UT WC Policy # WC 928978358184 applies to all other non-monopolistic states RE: Solicitation No.: BPM001022, Registry Staffing Services for the Arizona State Hospital Additional Insured: State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees where required by written contract.

POLICY NUMBER: COMMERCIAL GENERAL LIABILITY

CG 20 26 04 13

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

CG 20 26 04 13 © Insurance Services Office, Inc., 2012 Page of

ADDITIONAL INSURED – DESIGNATED

PERSON OR ORGANIZATION

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

Name Of Additional Insured Person(s) Or Organization(s):

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 contract 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 shall not increase the applicable Limits of Insurance shown in the Declarations.

PPK2709885

Any person or organization where required by a written contract executed prior to the occurrence of a loss. Such person or organization is an additional Insured for 'bodily injury", "property damage" or "personal and advertising injury" but only for liability arising out of the negligence of the named insured.

1 1

POLICY NUMBER: COMMERCIAL GENERAL LIABILITY

CG 24 04 05 09

CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY

AGAINST OTHERS TO US

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART

SCHEDULE

Name Of Person Or Organization:

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV – Conditions:

We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products-completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above.

PPK2709885

Any person or organization where required by a written contract which is executed prior to the occurrence of a loss to waive your rights of recovery, except for a loss resulting from the sole negligence from that person or organization

PI-GL-005 (07/12)

Page of Includes copyrighted material of Insurance Services Office, Inc., with its permission.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

ADDITIONAL INSURED

PRIMARY AND NON-CONTRIBUTORY INSURANCE

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

SCHEDULE

Effective Date: 04/01/2025

Name of Person or Organization (Additional Insured):

State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees

SECTION II – WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s) shown in the endorsement Schedule, but only with respect to liability for “bodily injury,” “property damage” or “personal and advertising injury” arising out of or relating to your negligence in the performance of “your work” for such person(s) or organization(s) that occurs on or after the effective date shown in the endorsement Schedule.

This insurance is primary to and non-contributory with any other insurance maintained by the person or organization (Additional Insured), except for loss resulting from the sole negligence of that person or organization.

This condition applies even if other valid and collectible insurance is available to the Additional Insured for a loss or ”occurrence” we cover for this Additional Insured.

The Additional Insured’s limits of insurance do not increase our limits of insurance, as described in

SECTION III – LIMITS OF INSURANCE.

All other terms, conditions, and exclusions under the policy are applicable to this endorsement and remain unchanged.

1 1

PI-TS-013 (05/12)

©2012 Philadelphia Indemnity Insurance Company

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

BLANKET ADDITIONAL INSURED ENDORSEMENT

(Including Waiver of Subrogation)

This endorsement modifies and is subject to the insurance provided under the following:

STAFFING SERVICE PROFESSIONAL LIABILITY COVERAGE FORM

STAFFING SERVICE PROFESSIONAL LIABILITY COVERAGE FORM CLAIMS MADE COVERAGE

FORM

A. The following is added to SECTION II – WHO IS AN INSURED:

Any person or organization where required by contract executed prior to a loss is an insured, but only with respect to that person’s or organization’s liability for “damages” arising out of a “wrongful act” during the rendering of ”staffing services”.

B. Paragraph I. in SECTION IV. CONDITIONS is deleted in its entirety and replaced with the following:

Transfer of Rights of Recovery Against Others To Us

If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring “suit” or transfer those rights to us and help us enforce them.

The insured can waive the insurer’s rights of recovery prior to the occurrence of a loss, provided the waiver is made in a contract.

POLICY NUMBER: PPK2709885 COMMERCIAL AUTO

CA 20 48 02 99

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 oo

DESIGNATED INSURED

This endorsement modifies insurance provided under the following:

BUSINESS AUTO COVERAGE FORM

GARAGE COVERAGE FORM

MOTOR CARRIER COVERAGE FORM

TRUCKERS COVERAGE FORM

With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement.

This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provi-sion of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form.

This endorsement changes the policy effective on the inception date of the policy unless another date is indi-cated below.

Endorsement Effective: Countersigned By:

Named Insured:

(Authorized Representative)

SCHEDULE

Name of Person(s) or Organization(s):

(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.)

Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form.

Any person or organization where required by a written contract executed prior to the occurrence of a loss.

POLICY NUMBER: PPK2709885 COMMERCIAL AUTO

CA 04 44 03 10

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

CA 04 44 03 10 © Insurance Services Office, Inc., 2009 Page 1 of 1

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY

AGAINST OTHERS TO US (WAIVER OF SUBROGATION)

This endorsement modifies insurance provided under the following:

BUSINESS AUTO COVERAGE FORM

BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM

GARAGE COVERAGE FORM

MOTOR CARRIER COVERAGE FORM

TRUCKERS COVERAGE FORM

With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi-fied by the endorsement.

This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below.

Named Insured:

Endorsement Effective Date:

SCHEDULE

Name(s) Of Person(s) Or Organization(s):

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

The Transfer Of Rights Of Recovery Against Oth-ers 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 "ac-cident" or the "loss" under a contract with that person or organization.

Any person or organization where required by a written contract executed prior to the occurrence of a loss.

PI-CA-023 (07/19)

PI-CA-023 (07/19)

Includes copyrighted material of Insurance Services Office, Inc., with permission.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

PRIMARY AND NONCONTRIBUTORY – OTHER INSURANCE

CONDITION

This endorsement modifies insurance provided under the following:

AUTO DEALERS COVERAGE FORM

BUSINESS AUTO COVERAGE FORM

GARAGE COVERAGE FORM

With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement.

A. The following is added to the Other Insurance Condition in the Business Auto Coverage Form and supersedes any provision to the contrary:

This Coverage Form’s Covered Autos Liability Coverage is primary to and will not seek contribution from any other insurance available to an “insured” under your policy provided that:

1. Such “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 such “insured”.

B. The following is added to the Other Insurance Condition in the Auto Dealers Coverage Form and the Garage Coverage Form and supersedes any provision to the contrary:

This Coverage Form’s Covered Autos Liability Coverage and General Liability Coverages are primary to and will not seek contribution from any other insurance available to an “insured” under your policy provided that:

1. Such “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 such “insured”.

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY

This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.

(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)

Endorsement Effective 04/01/2025 Policy No. WC1014656 Insured Concentric Healthcare Solution

Endorsement No.

Premium $

Insurance Company Pacific Compensation Insurance Company Countersigned by

Authorized Representative

WC 00 03 13

(Ed. 04-1984)

© Copyright 1983 National Council on Compensation Insurance, Inc. All Rights Reserved.

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

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.)

This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.

Schedule

Anyone for whom you have agreed to provide this Waiver subject to the terms of the endorsement.

States: AZ, CO, ID, IL, LA, MT, NV, OK, UT

This endorsement changes the policy to which it is attached and, unless otherwise stated, is effective on the date issued at 12:01 A.M. standard time at your mailing address shown in the policy. The information below is required only when this endorsement is issued subsequent to commencement of the policy.

Endorsement Effective 04/01/2025 Policy No. WC1014656 Insured Concentric Healthcare Solution

Endorsement No.

Premium $

Insurance Company Pacific Compensation Insurance Company Countersigned by

Authorized Representative

WC 99 03 15 A

(Ed. 05-2023)

Contains Copyrighted material of WCIRB, used with permission

CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - BLANKET

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).

Schedule

Anyone for whom you have agreed to provide this Waiver subject to the terms of the endorsement

This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.

(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)

Endorsement Effective 04/01/2025 Policy No. WC1014656 Insured Concentric Healthcare Solution

Endorsement No.

Premium $

Insurance Company Pacific Compensation Insurance Company Countersigned by

Authorized Representative

WC 42 03 04 B

(Ed. 06-2014)

© Copyright 2014 National Council on Compensation Insurance, Inc. All Rights Reserved.

TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

This endorsement applies only to the insurance provided by the policy because Texas is shown in Item 3.A. of the Information Page.

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, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule where you are required by a written contract to obtain this waiver from us.

This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule.

The premium for this endorsement is shown in the Schedule.

Schedule

1. () Specific Waiver

(x) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver.

2. Operations: All Texas Operations

3. Premium:

The premium charge for this endorsement shall be 2% percent of the premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described.

4. Advance Premium:

PI-CANXAICH-002 (05/11)

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

CANCELLATION NOTICE TO SCHEDULED ADDITIONAL INSURED OR

CERTIFICATE HOLDER

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

PROFESSIONAL LIABILITY COVERAGE PART

COMMERCIAL CRIME COVERAGE PART

COMMERCIAL INLAND MARINE COVERAGE PART

COMMERCIAL PROPERTY COVERAGE PART

COMMERCIAL AUTOMOBILE COVERAGE PART

SCHEDULE OF ADDITIONAL INSUREDS OR CERTIFICATE HOLDERS

AI or CH Additional Insured or Certificate Holder Address CH & AI Any person or organization with whom you have agreed to provide 30 days prior written notice of cancellation as provided by your insurance broker of such person or organization and that list is provided to us prior to any such cancellation

Various

The following is added to A. CANCELLATION of the Common Policy Conditions of the above applicable coverage part:

A. In the event we cancel the policy in accordance with the policy’s terms and conditions, we will endeavor to mail written notice of cancellation to Additional Insureds or Certificate Holders, shown in the above SCHEDULE within the time frame listed below. However, failure to mail such notice shall impose no obligation of any kind upon us, our agents or representatives.

1. 30 days before the effective date of cancellation if we cancel for any reason other than for non - payment of premium.

As respects Additional Insureds, the above cancellation provision applies only when the Additional Insured shown in the above SCHEDULE is added to the policy by a separate additional insured endorsement as the CANCELLATION NOTICE TO ADDITIONAL INSURED OR CERTIFICATE HOLDER does not provide additional insured coverage.

CG 00 01 04 13 © Insurance Services Office, Inc., 2012 Page 13 of 16

b. Those statements are based upon representations you made to us; and

c. We have issued this policy in reliance upon your representations.

7. Separation Of Insureds

Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this Coverage Part to the first Named Insured, this insurance applies:

a. As if each Named Insured were the only Named Insured; and

b. Separately to each insured against whom claim is made or "suit" is brought.

8. Transfer Of Rights Of Recovery Against Others To Us

If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them.

At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them.

9. When We Do Not Renew

If we decide not to renew this Coverage Part, we will mail or deliver to the first Named Insured shown in the Declarations written notice of the nonrenewal not less than 30 days before the expiration date.

If notice is mailed, proof of mailing will be sufficient proof of notice.

SECTION V – DEFINITIONS

1. "Advertisement" means a notice that is broadcast or published to the general public or specific market segments about your goods, products or services for the purpose of attracting customers or supporters. For the purposes of this definition:

a. Notices that are published include material placed on the Internet or on similar electronic means of communication; and

b. Regarding web sites, only that part of a web site that is about your goods, products or services for the purposes of attracting customers or supporters is considered an advertisement.

2. "Auto" means:

a. A land motor vehicle, trailer or semitrailer designed for travel on public roads, including any attached machinery or equipment; or

b. Any other land vehicle that is subject to a compulsory or financial responsibility law or other motor vehicle insurance law where it is licensed or principally garaged.

However, "auto" does not include "mobile equipment".

3. "Bodily injury" means bodily injury, sickness or disease sustained by a person, including death resulting from any of these at any time.

4. "Coverage territory" means:

a. The United States of America (including its territories and possessions), Puerto Rico and Canada;

b. International waters or airspace, but only if the injury or damage occurs in the course of travel or transportation between any places included in Paragraph a. above; or

c. All other parts of the world if the injury or damage arises out of:

(1) Goods or products made or sold by you in the territory described in Paragraph a.

above;

(2) The activities of a person whose home is in the territory described in Paragraph a.

above, but is away for a short time on your business; or

(3) "Personal and advertising injury" offenses that take place through the Internet or similar electronic means of communication;

provided the insured's responsibility to pay damages is determined in a "suit" on the merits, in the territory described in Paragraph

a. above or in a settlement we agree to.

5. "Employee" includes a "leased worker".

"Employee" does not include a "temporary worker".

6. "Executive officer" means a person holding any of the officer positions created by your charter, constitution, bylaws or any other similar governing document.

7. "Hostile fire" means one which becomes uncontrollable or breaks out from where it was intended to be.

8. "Impaired property" means tangible property, other than "your product" or "your work", that cannot be used or is less useful because:

a. It incorporates "your product" or "your work" that is known or thought to be defective, deficient, inadequate or dangerous; or

b. You have failed to fulfill the terms of a contract or agreement;

if such property can be restored to use by the repair, replacement, adjustment or removal of "your product" or "your work" or your fulfilling the terms of the contract or agreement.

POLICY NUMBER: PHPK2536155

PI-TS-003 (12/11)

Includes copyrighted material of Insurance Services Office, Inc., with permission

©2011 Philadelphia Indemnity Insurance Company

2. Those statements are based upon representations you made to us; and

3. We have issued this policy in reliance upon your representations.

H. Separation Of Insureds

Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this Coverage Part to the first Named Insured, this insurance applies:

1. As if each Named Insured were the only Named Insured; and

2. Separately to each insured against whom claim is made or “suit” is brought.

I. Transfer of Rights Of Recovery Against Others To Us

If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring “suit” or transfer those rights to us and help us enforce them.

J. Governmental Immunity

If you are a public institution, you may be entitled to governmental immunity. This Coverage Part does not constitute a waiver of any charitable or governmental immunity to which you are entitled.

K. Settlement

If the first Named Insured refuses to consent to any settlement recommended by us, and acceptable to the claimant, and elects to further contest the claim or “suit,” subject to the provisions of SECTION III – LIMITS OF INSURANCE, our liability for such claim or “suit” shall not exceed the amount for which the claim or “suit” could have been settled, plus the cost of defense incurred by us up to the date of such refusal, plus 50% of covered “damages” and “claim expenses” in excess of such settlement amount. It being a condition of this insurance that the remaining 50% of such “damages” and “claim expenses” excess of the first settlement amount shall be borne by you at your own risk and be uninsured.

Notwithstanding the foregoing, this provision shall not apply until the settlement amount exceeds the Deductible amount stated in the Staffing Service Professional Liability Declarations.

L. Two or More Coverage Parts Or Policies Issued By Us

It is our stated intention that the various coverage parts or policies issued to you by us, or any company affiliated with us; do not provide any duplication or overlap of coverage for the same claim or “suit.” If this policy and any other coverage part or policy issued to you by us, or any company affiliated with us, apply to the same “wrongful act,” occurrence, offense, accident or loss, the maximum limit of insurance under all such coverage parts or policies combined shall not exceed the highest applicable limit of insurance under any one coverage part or policy.

This condition does not apply to any Excess or Umbrella Policy issued by us specifically to apply as excess insurance over this policy.

M. When We Do Not Renew

If we decide not to renew this Coverage Part, we will mail or deliver to the first Named Insured shown in the Declarations written notice of the nonrenewal not less than 30 days before the expiration date.

PI-MANU-1 (01/00)

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY

All other terms and conditions of this Policy remain unchanged.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

VIRGINIA - PROFESSIONAL LIABILITY CLAIMS MADE AND REPORTED COVERAGE AMENDED

LIMIT ENDORSEMENT

MANUSCRIPT 495 (03/22)

This endorsement modifies insurance provided under

STAFFING SERVICE PROFESSIONAL LIABILITY CLAIMS-MADE COVERAGE FORM

1. The following provision is added to SECTION III - LIMITS OF

INSURANCE:

The Each Wrongful Act Limit of Insurance shown on the Staffing Service

Professional Liability Declarations Claims Made attached to the policy is amended to equal but not exceed the total amount recoverable for any injury or death of a patient as shown in § 8.01-581.15 of the Code of Virginia as applicable for the year in which a claim is submitted to "us" for a

"wrongful act", but only when such injury or death arises out of the rendering or failure to render "Allied Healthcare" "Staffing Services" by a

"Staffing Service Employee" of the Insured. This provision applies in the following situations:

a. In any verdict returned against a "Staffing Service Employee" in an action for malpractice which is tried by a jury; or

b. In any judgement entered against a "Staffing Service Employee" in such an action which is tried without a jury.

The Aggregate Limit of Insurance shown on the Staffing Service Professional

Liability Declarations Claims Made attached to the policy is amended to equal but not exceed three times the amount recoverable for any injury or death of a patient as shown in § 8.01-581.15 of the Code of Virginia as applicable for the year in which a claim is submitted to "us" for a

"wrongful act", but only when such injury or death arises out of the rendering or failure to render "Allied Healthcare" "Staffing Services" by a

VIRGINIA - PROFESSIONAL LIABILITY CLAIMS MADE AND REPORTED COVERAGE AMENDE

POLICY NUMBER: PPK2709885

All other terms and conditions of this Policy remain unchanged.

"Staffing Service Employee" of the Insured.

These limits of insurance do not apply separately to each "Staffing Service

Employee" and shall supersede, but cannot be added to, any "wrongful acts" limits shown on the Staffing Service Professional Liability Declarations

Claims Made.

2. In order for the above to supersede the Each Wrongful Act and

Aggregate Limits of Insurance shown on the Staffing Service Professional

Liability Declarations Claims Made, the insured must be required through written contract executed prior to the occurrence of any loss to carry a

Professional Liability (Errors & Omissions) limit equal to the total amount recoverable for any injury or death of a patient as shown in § 8.01-581.15 of the Code of Virginia as applicable for the year in which a claim is submitted to "us" for a "wrongful act", or a Code of Virginia § 8.01-581.15 specific endorsement.

3. When this endorsement allows the Each Wrongful Act and Aggregate

Limits of Insurance shown on the Staffing Service Professional Liability

Declarations Claims Made to be superseded, the Each Claim or "Suit"

(including "Claim Expense") Deductible applying to any Claim or "Suit"

(including "Claim Expense) paid by "us" through the limits provided in 1.

above shall be the greater of:

a. $25,000; or

b. The amount shown on the Staffing Service Professional Liability

Declarations Claims Made attached to the policy

4. When this endorsement allows the Each Wrongful Act and Aggregate

Limits of Insurance shown on the Staffing Service Professional Liability

Declarations Claims Made to be superseded, the RETROACTIVE DATE & PRIOR AND

PENDING DATE shown on the Staffing Service Professional Liability

Declarations Claims Made are amended to the inception date of the written contract requiring the Insured to carry a Professional Liability (Errors &

Omissions) limit equal to the total amount recoverable for any injury or death of a patient as shown in § 8.01-581.15 of the Code of Virginia as applicable for the year in which a claim is submitted to "us" for a

"wrongful act", or a Code of Virginia § 8.01-581.15 specific endorsement.

All other terms and conditions of this Policy remain unchanged.

These RETROACTIVE DATE & PRIOR AND PENDING DATE will apply:

a. Only to claims paid by "us" through the limits provided in 1. Above;

and

b. Separately to each contract requiring such limits

All other terms and conditions remain the same.