HomeMy WebLinkAbout*Other - BOCC (003)7112701
2038 1st Avenue South
Saint Petersburg, FL 33712
Phone:(727) 290-9801 Fax: (727) 498-6506
Date: February 6, 2023
To: Shane Heston
Trask Insurance Agency
From: Korina Blair, Assistant Broker
Phone: 727-290-9801 Email: Korina.Blair@founderspro.com
On Behalf of: Linda Wright
Re: Insured: dba Renew Grant Behavioral Health and WellnessGrant County
Proposed Effective Date: 2/15/2023
Attached please find a quotation from Admiral Insurance Company (ADM) for the above
mentioned account. Please be sure to check it over for accuracy. If you have any
questions, please contact your broker, Linda Wright at Linda.Wright@founderspro.com
or (727) 873-7915.
This policy is quoted on a non -admitted basis. We will be filing the taxes on your
behalf. The surplus lines taxes and fees will be included with the premium billing.
'Please note: underwriting review and acceptance of any subjectivities listed on the
quote are required prior to binding this quote***
POLICY PERIOD: 2/15/2023 TO 2/15/2024
TERM: 12 Months
PREMIUM: $5,000.00
FEES: Broker Fee $250.00
TAXES: $110.25
TOTAL: $5,360.25
COMMISSION: 13.5%
AA
P V
FEB 0 7 Z023
We appreciate your business. Please let us know how we can further assist you in
placing this coverage for your client.
Thank you!
F 2102, if)
KWAX 90A
1N,*SLTRANCE GROUP'
FA.M. Best Rating: A+ (Superior) Financial Size Category: XV
Reference: 0490LV001
Subject: GRANT COUNTY
DBA: RENEW - GRANT
BEHAVIORAL HEALTH
AND WELLNESS
Carrier: Admiral Insurance Company
QUOTE
Coverage Medical Professional Liability (Claims Made)
Business Service: outpatient community health clinic providing mental health counseling and medication management ONLY
Limits of Liability:
Professional Liability (PL) Each Claim $1,000,000
Aggregate $3,000,000
Sexual Abuse Each Claim $100,000
Aggregate $300,000
Claim Expenses Aggregate Limit $1,000,000
Additional Coverages: Each Claim Aggregate
Network Security & Data Privacy Liability $1,000,000 $1,000,000
First Party Privacy Breach Expenses $100,000 $100,000
Media Activities $25,000 $25,000
Regulatory Wrongful Acts $25,000 $25,000
HIPAA $250,000 $250,000
License Defense $5,000 $25,000
Peer Review Expenses $5,000 $25,000
Subpoena Assistance $5,000 $5,000
Reimbursement of Lost Wages or Earnings $500 $5,000
Reputation Protection Coverage $5,000 $5,000
Emergency Evacuation Expenses $25,000 $25,000
Patient Property Damage $500 $500
Policy Aggregate Limit: $3,000,000
PL Deductible: $2,500 Per Claim - Including Expenses
PL Retroactive Date: Inception
Premium: $5v000 Flat Rate
Minimum Retained Premium: 25% Minimum Retained at Inception
This 2uote is valid 30 days. This quotation may not include all terms and conditions reouested.
TERMS & CONDITIONS
Schedule of Forms & Endorsements
JA10010720 COVER JACKET - ADMIRAL INSURANCE COMPANY
DE23270820 ADMIRALPRO DELTA MED PROFESSIONAL LIABILITY DECLARATIONS PAGE
E012600813 NON PARTICIPATION DISCLOSURE NOTICE TO POLICY HOLDERS ALL STATES PATIENTS COMPENSATION FUNDS AND
INSUREDS WARRANTY OF COMPLIANCE
E013260820 ADMIRALPRO DELTA MED MISCELLANEOUS MEDICAL PROFESSIONAL LIABILITY INSURANCE
E013270816 DESIGNATED LOCATION ENDORSEMENT
E013300520 SPECIFIED OPERATIONS ABSOLUTE EXCLUSION - NURSING HOMES AND ASSISTED LIVING FACILITIES
E013360816 SPECIFIED OPERATIONS EXCLUSION (ABSOLUTE)
E013390816 PROFESSIONAL LIABILITY TERRORISM EXCLUSION (ABSOLUTE)
E014120721 SPECIFIED TREATMENT EXCLUSION - REGENERATIVE MEDICINE
A144020821 SERVICE OF SUIT
MKO1201121 LOSS CONTROL AND RISK MANAGEMENT SERVICES FOR HEALTHCARE PROFESSIONAL LIABILITY POLICYHOLDERS
IMKO1220619 ADMIRAL CYBER BREACH COACH EVENT HOTLINE
COMMENTS
AdmiralPro Delta MED Policyholder Additional Benefits
Admiral Insurance Group has partnered with OmniSure Consulting Group, a leading risk management
consultancy for healthcare professionals, to provide our AdmiralPro Delta MED policyholders with important
Page 1 of 2
FM5110 (07/20)
free benefits including loss prevention assistance, risk management guidance documents industry newsletters
and more. To find out more about OmniSure, please visit their website at hl!p:Hadmiral-health.omnisure.com.
Page 2 of 2
FM5110 (07/20)
A 1-Ifelaware Corporatiml.
■ N �N
THIS POLICY CONSISTS OF:
In Witness Whereof, we have caused this policy to
law, this policy shall not be valid unless countersig
W. Robert Berkley, Jr.
President
ed, and, if required by state
B.presentative.
P ' O ' 0 it
P �
Secret
Administrative Office: 7233 E. Butherus Drive, Scottsdale, AZ 85260 (480) 509-6627
Policy Issuing Office: 1000 Howard Blvd., Suite 300, P.O. Box 5430, Mount Laurel, NJ 08054
Telephone (856) 429-9200 Facsimile (856)429-8611
[JA 10 01 07 20]
Policy Number:
EO 12 60 08 13
Effective Date:
This endorsement modifies insurance providea under the following:
AM
PROFESSIONAL LIABILITY CO G PART
In consideration of the premium charged, is ura erstood and agreed that the following provisions apply.
I. NON -PARTICIPATION DISCLOS " NOTICE TO POLICYHOLDERS
THE COMPANY DOES NOT PARTICIP Y STATE'S PATIENTS' COMPENSATION FUND,
REGARDLESS OF FUND NAME, GOV ING S TUTE(S), OR GOVERNING BODY. ANY PERSON OR
ENTITY THAT IS REQUIRED BY ST LAW TO RTICIPATE IN ANY STATE'S PATIENTS'
COMPENSATION FUND (THE "FUND OR SIMI AR FUND IS SOLELY AND INDEPENDENTLY
RESPONSIBLE FOR SATISFYING ANY ALL FUND RELATED STATE STATUTES, REGULATIONS
AND/OR REQUIREMENTS IMPOSED BY ANY MEDIC OR OTHER LICENSING BOARD.
II. HEALTH CARE FUND EXCLUSION
THE COMPANY DOES NOT CAUSE TO BE F WITH ANY STATE DEPARTMENT OF INSURANCE
OR OTHER REGULATORY BODY PROOF OF FINANCIAL PONSIBILITY PURSUANT TO ANY AND
ALL FUND REQUIREMENTS AS HAVE BEEN OR MAY ABLISHED BY STATE LAW AND/OR BY
ANY FUND RELATED REGULATIONS. THE CO S NOT PAY ANY FUND RELATED
SURCHARGE OR ASSESSMENT THAT MAY BE A ES ON ANY INSURED AND/OR OTHER
HEALTH CARE PROVIDERS WHETHER THE SURCH ESSMENT IS IMPOSED BY LAW, BY
MEDICAL OR OTHER REGULATORY LICENSING BOARD, R BY ANY FUND RELATED
REGULATIONS.
III. ABSOLUTE COVERAGE EXCLUSION
THE EXCLUSION SECTION OF THE POLICY IS HEREBY AMEND CLUDE ANY OR ALL
CLAIMS BASED UPON, ARISING FROM OR IN ANY WAY R ° TO Y STATE'S PATIENTS'
COMPENSATION FUND AND/OR ANY RELATED STATUTES /O ULATIONS RELATED TO
ANY AND/OR ALL STATE PATIENTS' COMPENSATION FUND
IV. POLICYHOLDER WARRANTY
THE NAMED INSURED, INSUREDS AND ANY ADDITIONAL INSURED BY WARRANT THAT
ANY FUND OR OTHER RELATED PARTICIPATION REQUIREMENT AVE EN SATISFIED
INDEPENDENTLY OF THIS INSURANCE POLICY. INSURED' S FAILU T O WITH ANY AND
ALL MANDATORY PARTICIPATION REQUIREMENTS MAY IMPACT INS 'S AVAILABILITY OF
STATE PROVIDED COVERAGE AND/OR CAPS ON LIABILITY, AS WELL POTENTIALLY
JEOPARDIZE AN INSURED'S OR OTHER HEALTH CARE PROVIDER'S PROFESSIONAL LICENSE AND
EXPOSE INSUREDS TO FINES AND/OR PENALTIES. ALL INSUREDS ARE ADVISED TO CONSULT
WITH INDEPENDENT LEGAL COUNSEL TO ENSURE FULL COMPLIANCE WITH ANY AND ALL
STATUTES AND APPLICABLE REQUIREMENTS.
EO 12 60 08 13 Page 1 of 2 11
V. DEFINED TERMS AND COMPATABILITY WITH POLICY
ANY AND ALL VERSIONS OF DEFINED TERMS SHOWN IN THIS ENDORSEMENT CORRESPOND TO
THE DEFINED TERMS AS SHOWN IN THE POLICY TO WHICH THIS ENDORSEMENT IS ATTACHED.
ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED AND APPLY.
EO 12 60 08 13 Page 2 of 2 13
MISCELLANEOUS MEDICAL
PROFESSIONAL LIABILITY INSURANCE
THIS IS A CLAIMS -MADE PORTED POLICY. PLEASE READ THIS POLICY CAREFULLY. THE AMOUNT
OF THE APPLICABL TIMI F ABILITY WILL BE REDUCED BY THE AMOUNTS PAID FOR DAMAGES.
Throughout this Policy e w you and your refer to the Named Insured. The words Company, we, us, our and Company
refer to the Company as s n the Declar tions Page of this Policy (Company). Words which are in Bold writing throughout
this document are defined terms within the nitions section of this Policy. This Policy shall not be binding upon the Company
unless completed by a Declaration e a d countersigned on the aforesaid Declarations Page by a duly authorized
representative of the Compan
In consideration of the premium aid, in re lance upon the statements in the Application and subject to the terms and conditions
of this Policy (including all endorsements), the Co any agrees with the Named Insured as follows:
SECTION I. INSURING AGREEMENTS
COVERAGE A. PROFESSIONAL L T
We will pay on behalf of the Insure those amounts, in excess of the PL Deductible and subject to the Limit of Liability
for Professional Liability shown on t Declarations, which the Insured becomes legally obligated to pay as Damages
and Claim Expenses which directly result fro ssional Incident taking place within the Policy Territory,
subsequent to the retroactive date shown in th ' aration and prior to the expiration or termination date of this Policy,
for which a Claim is first made against the sured durin le Policy Period and reported to us in writing during the
Policy Period or any applicable Extended orting Perm , as described in SECTION IX. EXTENDED REPORTING
PERIOD.
COVERAGE B. SEXUAL ABUSE AND MOLESTATION
We will pay on behalf of the Insured those amounts, in of the PL Deductible and subject to the Limit of Liability
for Sexual Abuse and Molestation shown on the D ions, which the Insured becomes legally obligated to pay as
Damages and Claim Expenses which directly result m Sexual Abu and Molestation taking place within the Policy
Territory, subsequent to the retroactive date shown in the Declar nd prior to the expiration or termination date of
this Policy, for which a Claim is first made against the I s g the Policy Period and reported to us in writing
during the Policy Period or any applicable Extended R orti eriod, as described in SECTION IX. EXTENDED
REPORTING PERIOD.
SECTION II. ADDITIONAL COVERAGE INSURING AG
ADDITIONAL COVERAGE A. NETWORK SECURITY AND DAT PRIVACY LI BILITY
We will pay on behalf of the Insured those amounts, in excess of the PL Ded e d subject to the Limit of Liability
for Network Security and Data Privacy Liability shown on the Declar do ch the sured becomes legally obligated
to pay as Damages and Claim Expenses which directly result from a twor ecu ity and Data Privacy Wrongful
Act taking place within the Policy Territory, subsequent to the retroac 've da e shown on the Declarations and prior to
the expiration or termination date of this Policy, for which a Claim is fi °ade againsJorting
Insured during the Policy
Period and reported to us in writing during the Policy Period or any applicable Extende Period, as described
in SECTION IX. EXTENDED REPORTING PERIOD.
ADDITIONAL COVERAGE B. FIRST PARTY PRIVACY BREACH EXPENSE
We will pay on behalf of the Insured, Privacy Breach Expenses subject to theLimi ility for First Party Privacy
Breach Expenses shown on the Declarations, resulting directly from a Privacy Bre vent, provided that the Privacy
Breach Event first occurs on or after the retroactive date shown in the Declarations and prior to the expiration or
termination date of this Policy, the Privacy Breach Event is first discovered during the Policy Period, and the Privacy
Breach Event is reported to us during the Policy Period or any applicable Extended Reporting Period as described in
SECTION IX. EXTENDED REPORTING PERIOD, and no deductible shall apply.
EO 13 26 08 20 Page 1 of 18
ADDITIONAL COVERAGE C. MEDIA ACTIVITIES
We will pay on behalf of the Insured those amounts in excess of the PL Deductible and subject to the Limit of Liability
for Media Activities shown on the Declarations, which the Insured becomes legally obligated to pay as Damages and
Claim Expenses which directly result from Media Wrongful Acts during Media Activities taking place within the Policy
Territory, subsequent to the retroactive date shown in the Declarations and prior to the expiration or termination date of
the Policy, for which a Claim is first made against the Insured during the Policy Period and reported to us in writing
during the Policy Period or any applicable Extended Reporting Period as described in SECTION IX. EXTENDED
REPORTING PERIOD. T imum Amount Reimbursable is subject to the Limit of Liability for Media Activities
shown on the Declaration
ADDITIONAL CO GE ATORY WRONGFUL ACTS
A. We will reimbu nsured for any Costs, Charges and Expenses, Fines and Penalties and/or Audit Expenses
incurred by the Insured resultin rom an Insured Event taking place during the Policy Period and after the
retroactive date shown on the tions but prior to the expiration or termination date of this Policy and which is
the subject of a Reg la ron 1 Act which is first Instituted during the Policy Period or any applicable
Extended Reporting P d as ed in SECTION IX. EXTENDED REPORTING PERIOD. We shall have no
duty to defend the Ins red for such an Insured Event, but only to reimburse for covered Costs, Charges and
Expenses, Fines and Penalties and/or it Expenses. The Maximum Amount Reimbursable is subject to the
Limit of Liability for Regulatory Wr is shown on the Declarations and no deductible shall apply.
B. Regulatory Wrongful Acts Su en Con ions
1. All related Insured Events, 11 rel ed proceedings or consolidated proceedings, including any appeals and/or
post -hearing or post -trial pro c . gs, and all proceedings arising out of the same facts, circumstances or events
shall be considered a single Insured Eve all be deemed to have been Instituted at the time the earliest
Insured Event was Instituted.
2. A condition precedent to reimburse t of any co v d Costs, Charges and Expenses, Audit Expenses and/or
Fines and Penalties is that the Insu shall noti us no later than sixty (60) days from the date that an Insured
Event has been Instituted.
3. The insurance afforded by this coverage part applies o the Insured Event is Instituted after the retroactive
date shown on the Declarations.
4. Voluntary Self Disclosure: In the event an sts, Charges and Expenses, Audit Expenses and/or Fines and
ak
Penalties arise out of voluntary Self Disclos e, the Insure st establish that the circumstances giving rise to
the disclosure became known to the Insured fortuitous, sequent to the effective date of this Policy.
5. Reimbursement for Fines and Penalties: Subjec he imum Amount Reimbursable, we will reimburse
the Insured for Fines and Penalties which are the su dication by an administrative tribunal or
court, or are the subject of a settlement agreement o ipula gment for which we have given our prior
consent. The Insured shall not admit or assume any li b° ° r Fines and Penalties, enter into any settlement
agreement or stipulate to any judgment for Fines and P alties without , r prior written consent. Only those
settlements or stipulated judgments for Fines and Penalties to whic ave consented in writing shall be
reimbursable under this Policy. We will not unreasonably withhol ent.
6. Subject to the Maximum Amount Reimbursable.
7. Shadow Audit: The Insured shall not have a Shad
Audit and its expense. Subject to the Maximum Y
approved Shadow Audits will be reimbursed by th
ADDITIONAL COVERAGE E. HIPAA VIOLATION
A.
-oval of the Shadow
ses from previously
old their approval.
We will reimburse the Insured for any Costs, Charges and Expenses an&/or /Fia ealties incurred by the
Insured resulting from a HIPAA Violation taking place during the Policy Perioter the retroactive date shown
on the Declarations but prior to the expiration or termination date of this Policyhich is the subject of a HIPAA
Proceeding which is first Instituted during the Policy Period or any applicable Extended Reporting Period as
described in SECTION IX. EXTENDED REPORTING PERIOD. We shall have no duty to defend the Insured for
such HIPAA Violation or HIPAA Proceeding, but only to reimburse for covered Costs, Charges and Expenses,
and/or Fines and Penalties. The Maximum Amount Reimbursable for a HIPAA Violation is the Limit of Liability
for HIPAA shown on the Declarations and no deductible shall apply.
EO 13 26 08 20 Page 2 of 18
B. HIPAA Violation Supplemental Conditions
1. All related HIPAA Violations and/or HIPAA Proceedings, all related proceedings or consolidated proceedings,
including any appeals and/or post -hearing or post -trial proceedings, and all proceedings arising out of the same
facts, circumstances or events shall be considered a single HIPAA Violation and shall be deemed to have been
Instituted at the time the earliest HIPAA Proceeding was Instituted.
2. A condition precedent to reimbursement of any covered Cost, Charges and Expenses and/or Fines and Penalties
is that the Insured shall notify us no later than sixty (60) days from the date that a HIPAA Proceeding has been
Instituted.
3. The insura of ed this coverage part applies only if the HIPAA Proceeding is Instituted after the
retroactive ate al
n n the Declarations.
ADDITIONAL COVE LICENSE EFENSE COVERAGE
We will pay on behalf of the Insur ,ense Defense Costs arising solely out of any Hearing initiated and reported to
us in writing during the Policy d wi in the Policy Territory the sole subject of which is the restriction, suspension
or revocation of the Insur ice actice medicine, or license to prescribe controlled substances, or privileges to
practice at a healthcare faci ty.
We shall have the right and duty to defend th sured in any Hearing initiated during the Policy Period, including the
right to appoint counsel to defend the I en if any of the allegations of the Hearing are groundless, false or
fraudulent. We may make such i n of a Hearing as we deem expedient. Our right and duty to defend the
Insured in any Hearing ends whe e hav led up the applicable Limit of Liability for License Defense shown on the
Declarations and no deductible shall ply.
ADDITIONAL COVERAGE G. SUBPO i A AS SIST
We will pay on behalf of the Insured, Sub p xpen s if during the Policy Period, an Insured is served with a
subpoena issued by a third party and reque Subpoena istance. Such request for Subpoena Assistance must be
accompanied by a copy of the subpoena. may retain attorney to provide Subpoena Assistance to the Insured,
provided that:
A. the subpoena arises out of a lawsuit or proceeding to w no Insured is a party; and
B. no Insured has been engaged to provide advice o mony in connection with the subject lawsuit or proceeding,
nor has any Insured provided such advic stimony in the past in connection with the subject lawsuit or
01
proceeding. IL
Any notice the Insured gives us regarding a subpoena shall b - I d to be notification of a potential Claim under
SECTION X. REPORTING OF CLAIMS, EVENTS A I TS. The maximum amount we will pay on behalf
of the Insured for Subpoena Expenses is the Limit of Lia ility Sub o Assistance shown on the Declarations and
no deductible shall apply.
ADDITIONAL COVERAGE H. REPUTATION PROTECTION E
We will reimburse the Insured for Reputation Protection Expen e incurred and r rted to us by the Insured during the
Policy Period. The maximum amount we will reimburse the Insured for Re n rotection Expense is the Limit of
Liability for Reputation Protection shown on the Declarations and no .e shall ly.
ADDITIONAL COVERAGE I. EMERGENCY EVACUATION EXPEN
We will reimburse the Insured for Emergency Evacuation Expense in and
the Policy Period. The maximum amount we will reimburse the Insured for Em,
Limit of Liability for Emergency Evacuation Expense shown on the Declarations an
SECTION III. THE COMPANY'S RIGHTS AND DUTIES
1.
to us by the Insured during
vacuation Expense is the
uctible shall apply.
We have the right and duty to defend and pay on behalf of the Insured any Clai ses directly resulting from
any covered Claim to which this Policy applies and will do so even if the alle ns of the Claim are groundless,
false or fraudulent including the right to appoint counsel to defend the Insured. We may make such investigation of
any Claim as we deem expedient. Our right and duty to defend ends when we have used up the applicable Limit of
Liability in the payment of Damages and/or Claim Expenses or have tendered the applicable Limit of Liability to a
court of competent jurisdiction. We have no obligation or duty to defend any Claim for which coverage is excluded
or not afforded by this Policy and we are not obligated to pay any Claim Expenses incurred by the Insured in the
defense of any Claim not covered by this Policy.
EO 13 26 08 20 Page 3 of 18
2. We have the right to investigate, direct the defense, negotiate and, with the consent of the Named Insured, settle any
Claim as we deem practical. If the Named Insured refuses to accept the judgment of the trial or appellate court or
refuses to consent to any settlement we can negotiate, then subject to the Policy's remaining applicable Limit of
Liability, our liability for such Claim is limited to and shall not exceed:
A. the amount for which such Claim could have been resolved and Claim Expenses incurred through the date of
the Named Insured's refusal; and
B. fifty percent (50%) of any further covered Claim Expenses incurred following the date of the Named Insured's
refusal, with the r fifty percent (50%) of such further Claim Expenses and all Damages in excess of the
amount for hic e C im could have been settled to be the sole responsibility of, and paid by the Named
Insured.
3. We have the ri uty to pay on behalf of the Insured any Privacy Breach Expenses or License Defense Costs
to which this insurance applies tha irectly result from a covered Privacy Breach Event or Hearing. Our duty ends
when we have used up the a Limit of Liability in the payment of Privacy Breach Expenses or License
Defense Costs or ha e ed th emaining applicable Limit of Liability with a court of competent jurisdiction.
We have no obligatio r du t spond to or cover any Privacy Breach Expenses or License Defense Costs
directly relating to, in c nnection with or rising from a Privacy Breach Event or Hearing for which coverage is
excluded or not otherwise afforded by t olicy. We are not obligated to pay any Privacy Breach Expenses or
License Defense Costs incurred b n red prior to the Insured's reporting the Privacy Breach Event or
Hearing to us or which are e .c . o other e not covered by the Policy.
4. We have the right and duty to rburs e Insured for any Costs, Charges and Expenses, Audit Expenses, Fines
and Penalties, Emergency Ev ation Expenses, Subpoena Expenses or Reputation Protection Expense to
Which this insurance applies directly resultin 11 a HIPAA Violation, HIPAA Proceeding, Insured Event,
Emergency Evacuation, request for Su ' tance or request for Reputation Protection. Our duty to
reimburse ends when we have used up applicable Limit of Liability in the payment of Costs, Charges and
Expenses, Audit Expenses, Fines an Penalties, ergency Evacuation Expenses, Subpoena Expenses or
Reputation Protection Expense. We ave no duty to reimburse any Costs, Charges and Expenses, Audit
Expenses, Fines and Penalties, Emergenc vacuation Ex enses, Subpoena Expenses or Reputation Protection
Expense directly relating to, in connection with or arisi HIPAA Violation, HIPAA Proceeding, Insured
Event, Emergency Evacuation, request for Sub ssistance or request for Reputation Protection for which
coverage is excluded or not otherwise afforded b olicy. We have no duty to reimburse any Costs, Charges and
Expenses, Audit Expenses, Fines and Penal t s, Emergency vacuation Expenses, Subpoena Expenses or
Reputation Protection Expense incurred by the Insured p ' the Insured's reporting the HIPAA Violation,
HIPAA Proceeding, Insured Event, Emergency v , i request for Subpoena Assistance or request for
Reputation Protection to us or which is excluded or of rwis t covered by the Policy.
SECTION IV. DEFINITIONS
A. Additional Coverages means Network Security & Dat P ' y Liability, Privacy Breach Expenses, Media
Activities, Regulatory Wrongful Acts, ITTAA, License De se, Subpoena Assistance, Reputation Protection, and
Emergency Evacuation Expense.
B. Audit Expenses means fees and expenses for the services of a qu lif it pro sional incurred by the Insured in
the course of a Shadow Audit.
C. Billing Errors Proceeding means investigations or other proceedin Ins ituted agai t the Insured by a Qui Tam
Plaintiff, Government Entity or Commercial Payor, alleging th resentation o causing or allowing to be
presented, or being liable for the presentation of any actual or alleged errone lings by the Insured to a
government health benefit payor or Commercial Payor from which the Ills se and/or has received payment
or reimbursement.
D. Bodily Injury means physical injury, physical sickness or physical disease sust y any one person, including
death resulting from any of these at any time. Bodily injury does not inc e shock or emotional, mental or
psychological distress, injury, trauma or anguish, or other similar condition, unless such condition results solely and
directly from that one person's prior physical injury, physical sickness or physical disease otherwise covered under
this Policy.
E. Claim means:
1. a written demand received for money or services by any Insured resulting from a Professional Incident, Sexual
Abuse and Molestation, Network Security and Data Privacy Wrongful Act, or Media Wrongful Act;
EO 13 26 08 20 Page 4 of 18
2. service of a Suit.
F. Claim Expenses means:
G.
I.
J.
K.
1. Fees, costs and expenses resulting from the investigation, adjustment, settlement and defense of a Claim;
2. Allowable expenses for the compensation of all Insureds for personally attending any legal proceeding at our
request however these allowable expenses shall be subject to the Limit of Liability for Reimbursement of Lost
Wages shown on the Declarations and no deductible shall apply;
3. The premiums for 1, attachment or similar bonds, but only for bond amounts within the applicable Limits
of Liability. e of ve to furnish these bonds;
4. Prejudg t int t rded against the Insured on that part of any covered judgment we pay. If we make an
offer to pa the licable Limits of Liability, we will not pay any prejudgment interest based on that period of
time after th er;
5. All interest on the full a any covered judgment that accrues after entry of the judgment and before we
have paid,. offer d or e tendered or deposited to a court of competent jurisdiction the part of the
judgment that is in th able Limits of Insurance.
Commercial Payor means any private ealth insurance company or managed care organization; however,
Commercial Payor does not includJa motive insurance companies in their capacity as such.
Costs, Charges and Expens s to y's fees and expenses for legal services rendered in the investigation,
defense, and appeal of any In d OC® ts, Charges and Expenses do not include:
1. Remuneration, salaries, wa , overhead, fees or benefits of, or paid to, any Insured or the insurer;
2. The costs associated with the adoption a lementation of any corporate integrity agreement, compliance
program or similar provision regardin era s of the Insured's business, negotiated as part of a settlement
with or by order of a federal or state ulatory bo d .
Damages means a monetary and compe I tory judgna t, award or settlement, however, Damages do not include and
we do not pay or reimburse:
1. amounts which are a multiple of compensatory Dama
2. fines, penalties, sanctions, taxes or fees assesse st any Insured;
3. judgments or awards arising from acts deem ninsurable by aw;
4. fees owed to the Insured and any amounts incurred to col ch fe(
5. the return of fees or other compensation paid to aQyJW
6. past, present and future earned and unearned roy ltie;
unlawfully or unjustly held or obtained, including theA
profits, fees, costs, expenses, commissions, and profits
7. non -pecuniary relief.
costs, expenses, commissions, and profits
I orgement or restitution of such royalties,
or unjustly held or obtained;
Direct Patient Care means examination, diagnosis, testing or treatment,,"Joffe",
e
Emergency Evacuation means an evacuation of the Insured's pC�ng
t t be
upon imminent danger from an external event or a condition whic se
patients. Emergency Evacuation shall not include an evacuation aout of:
1. a strike, bomb threat or false fire alarm, unless vacating is ordered by a civil
2. a planned vacating drill;
3. the relocation of one or more patients that is due and confined to their
4. nuclear hazard;
5. war and military action.
ersonally to a patient.
r' during the Policy Period based
oss of life or harm to the Insured's
ndition;
L. Emergency Evacuation Expenses means the reasonable and necessary expenses incurred by an Insured in the
performance of an Emergency Evacuation, including the costs of transportation and relocation of patients.
M. EMTALA Proceeding means proceedings Instituted against the Insured by a Government Entity alleging
violations of the Emergency Medical Treatment and Labor Act (EMTALA).
N. Event means an Insured Event, Privacy Breach Event, Regulatory Wrongful Act, HIPAA Violation, Hearing,
Emergency Evacuation, a request for Subpoena Assistance, or a request for Reputation Protection Expense.
EO 13 26 08 20 Page 5 of 18
O. Fines and Penalties means civil fines or penalties levied upon the Insured by a governmental or industry regulatory
body arising from a covered Insured Event or HIPAA Proceeding. Fines and Penalties do not include:
1. matters uninsurable under the law, or
2. any costs incurred to comply with or to fulfill an injunction or non -monetary judgment or order, or
3. any costs incurred to comply with or to fulfill a contractual requirement or mandate.
P. Good Samaritan Act means services rendered, or failed to be rendered, as a professional during a sudden and
unforeseen emergency ich no fee is expected, demanded or received.
Q. Government E ity ans:
1. Any depa ment ency, task force or other organization created by any United States federal or state law,
regulation, executive order;
2. Any department, agency, to ce or other organization operated, funded or staffed, in whole or in part, by the
United States federal en or any state government; or
3. With respect to g Proceedings, any organization operating as a Medicare Integrity Program
Contractor.
R. Hearing means a formal administrate roceeding or series of proceedings, including any investigation or
investigations related thereto, cond y Medical Licensing Board or Healthcare facility. A series of related
proceedings arising out of the ations nd before the same administrative body, shall constitute one Hearing.
S. HIPAA Proceeding means pro eedin nstituted against the Insured by a Government Entity alleging violation
of the Health Insurance Portabili Accountability Act (HIPAA) privacy regulations.
T. HIPAA Violation means an actual or alle . ion by the Insured of the Health Insurance Portability and
Accountability Act (HIPAA) privacy reg � ns.
U. Instituted means the time formal writt notice of a sured Event is served upon or otherwise received by the
Insured.
V. Insured means:
1. the Named Insured;
2. your current and former employees, tem employees, leased personnel, principals, partners, executive
officers, directors, members, managers, stoc olders, students rustees, volunteers, or Medical Directors while
acting on your behalf within the course and scope of their ,
3. in the event of death or incapacity of any Insure t e epresentative in his or her capacity as such, for any
Claim against the Insured;
M
4. your lawful spouse or legally recognized domestic pa sole aeon of their legal status., or their ownership
interest in property or assets that are sought as recove all not apply to the extent a Claim alleges any
Professional Incident, Network Security and Privac ongful Act orMedia Wrongful Act by such spouse
or legally recognized domestic partner who does not othe wise qualify nsured;
5. any Newly Acquired Entity;
Insured shall not include physicians, dentists, chiropractors, natu athic ti oners, podiatrists, nurse midwives
or certified registered nurse anesthetists, unless specifically identifi as an nsured within the definition of Insured
or on an endorsement added to this Policy.
Insured's Computer System means computers and associated hardware, soft
devices and backup components owned, leased, operated or controlled bt
Service Provider, whether on-site or off-site, and used in the ordinary cou e c
Services; however it does not include hardware, firmware or software of any
terrestrial or satellite communication services to the Insured.
aware, including network
red, or an Outsourced
ksured's Professional
provider of connectivity,
X. Insured Event shall mean Billing Errors Proceeding, EMTALA Proceeding or Stark Proceeding Instituted
against the Insured.
Y. License Defense Costs means:
1. Fees charged by an attorney designated by us; and
2. All other fees, costs and expenses resulting directly from the investigation, adjustment and defense of an Insured
for a Hearing.
EO 13 26 08 20 Page 6 of 18
License Defense Costs do not include Fines or Penalties.
Z. Malicious Code means an unauthorized, unwanted or harmful program, code or script, including, but not limited to,
viruses, trojan horses, worms, time or logic bombs, spyware, malware, spiderware, ransomware or other electronic
infections.
AA. Maximum Amount Reimbursable means the sum of all covered Costs, Charges and Expenses, Audit Expenses
or Fines and Penalties that will be reimbursed for an Insured Event.
BB. Media means material o ' . ormation in audio, digital, electronic, broadcast or printed format including software.
CC. Media Activities me the 'splay, broadcast, dissemination, distribution or release of Media by an Insured.
DD. Media Wron ul A m , s any of the following actual or alleged unintentional and unknown conduct directly
resulting from ur dia Activities:
1. libel, slander or defamation;
2. invasion or infringeme n i ividual's right to privacy or publicity;
3. disparagement o er , products or services;
4. plagiarism or misappropriation of ide ;
5. infringement of copyright, tradem e, slogan, trade name, trade dress, service mark, service name; or
6. detrimental reliance upo th ent c tent of Media.
EE. Mediation means the volunta and no nding process by which the Insured and claimants agree to use a neutral
and qualified third party to inter de between the Insured and claimants with the intention to reconcile the Insured
and claimant to resolve a Claim. ourt ordered or imposed mediation or other court ordered dispute resolution are
not considered Mediation for the purposes age.
FF. Medical Director means a physician or er healthcar professional employed or contracted by the Named Insured
specifically to serve as Medical Director
GG. Named Insured means the entity or indi al named in the Declarations.
HH. Network Security and Data Privacy Wrongful Act me e Insured's unintentional and unknowing failure to
prevent a Privacy Breach Event or failure to prevent U orized Access or Unauthorized Use that directly results
in:
1. the inability of an authorized third party user access the In ed's Computer System;
2. the inability of an authorized third party user to access ' computer, communication or network systems;
3. the failure or corruption of a third party's comput , co nication or network systems;
4. the transmittal or distribution of Malicious Code 's Computer System to a third party's
computer, communication or network systems;
5. the perpetuation of a denial of service attack on a third p 's computer, communication or network systems;
6. the violation of a Privacy Law;
7. invasion of an individual person's right to privacy or publici
8. unauthorized disclosure, release, theft or loss of Protected In matio cluding Protected Information in the
care, custody or control of an Outsourced Service Provider. 4.
II. Newly Acquired Entity means any entity formed or acquired by the Named Ins and in which the Named
Insured has more than 50% of the legal or beneficial interest, or a joint venture o ship that the Named Insured
becomes a member of, during the Policy Period but only if all of the follo con ons aij met:
1. within 90 days of the formation of a Newly Acquired Entity, the Named s notifies the Company in
writing of the details of such merger, acquisition, or newly created joint ven r partnership; and
2. the Named Insured has agreed in writing to any changes in terms and conditions of this Policy related to the
Newly Acquired Entity and paid any additional premium, if any, charged by the Company; and
3. the Company has issued a written endorsement specifically noting the addition of the Newly Acquired Entity as
a Named Insured under this Policy.
JJ. Other Insurance includes, but is not limited to, insurance coverage or benefits provided by self-insurance
arrangements, pools, self-insurance trusts, captive insurance companies, inter -insurance exchanges, mutual insurance
EO 13 26 08 20 Page 7 of 18
companies, stock insurance companies, risk retention groups, reciprocal exchanges, mutual benefit or assistance
programs, or any other plan or agreement of risk assumption.
KK. Outsourced Service Provider means a third party independent contractor that provides processing, maintaining or
storing of Protected Information or hosting of computer applications for the Named Insured under a written contract
with the Named Insured.
LL. Patient Property Damage means physical injury to, destruction or loss of use of tangible property sustained by your
patient.
MM. Personal Injury mea nju caused by one or more of the following offenses:
1. false arr dete n o prisonment;
2. malicious ose on;
3. wrongful entry or wrongful e tion;
4. invasion of right of pri ccu ncy.
NN. Policy Period means eri he inception date stated in the Declarations to the expiration date stated in the
Declarations, or its earls r termina ion date, if any.
00. Policy Territory means anywhere in t orld except countries or states against which the United States has
implemented trade or diplomatic sa
PP. Privacy Breach Event meas. ua.l rea ably suspected failure of the Insured, or an Outsourced. Service
Provider, to prevent the the acci tal release or unintentional and unauthorized disclosure of Protected
Information.
QQ. Privacy Breach Expenses mean the follows ble and necessary expenses incurred by the Insured or for the
Insured, which are required in order for t cured to mply with applicable Privacy Laws or to minimize potential
Damages which may otherwise be cove under this P icy:
1. Notification Expense
Expenses charged by a vendor designate approved in iting by us to notify an individual person of the release
of Protected Information as a result of a Privacy B vent.
2. Credit Monitoring Expense
Expenses charged by a vendor designated o pproved in writ I&g by us to provide credit monitoring services to
an individual person affected by a Privacy Breach Ev d for a period of 12 months from the date of
enrollment in such credit monitoring services.
3. Cyber Investigation Expense
Expenses charged by a law firm or vendor designa
Breach Event in order to determine whether the Insurd
Such costs do not include (a) salaries, wages, fees, rem
or (b) costs or expenses incurred to prevent future or sub
Cyber Investigation Expense does not mean the costs (
remediate, repair, correct, enhance, upgrade or otherwise
Computer System.
4. Crisis Management Expense
ap'01kwriting by us to investigate a Privacy
obligation to provide notice under Privacy Law..
ation, overhea , benefits or expenses of an Insured,
quent Privac ach Events.
Expenses charged by a public relations firm, law firm or crisis management
by us to perform crisis management services in order to minimize pe
Breach Event.
5. Call Center Expenses
Expenses charged by a third party call center, designated or approved in
individuals affected by such Privacy Breach Event.
or incurred to restore, replace,
make changes to the Insured's
d or approved in writing
;sulting from a Privacy
by us, to answer the questions of
EO 13 26 08 20 Page 8 of 18
6. Legal Expenses
Expenses charged by attorneys designated or approved in writing by us, in order to determine the Insured's
indemnification rights under a written contract with any independent contractor, third party vendor or Outsourced
Service Provider that may be legally responsible for the Privacy Breach Event.
RR. Privacy Law means statutes pertaining to the protection and collection of non-public personal identifiable information
as defined in those statutes.
SS. Professional Incident s a negligent act, error or omission in the rendering of or failure to render Professional
Services by the Insur or erson acting under the Insured's direction, control or supervision and for whose acts,
errors or omis ' his t nsu is legally liable. All Professional Incidents that are logically or causally connected
will be deeme one fe ional Incident that, for the purpose of determining coverage under this Policy, occurred
at the time of t q st negligent act, error or omission.
TT. Professional Services means .ces performed in person, by telephone or by other form of electronic
communication, by an Insu r o ers involving specialized training, knowledge and skill while in pursuit of the
profession or service 1 the iness Description on the Declarations, including Good Samaritan Acts.
UU. Property Damage mea � s:
1. physical injury to or destruction of t ' le property, including all resulting loss of use of that property; or
2. loss of use of tangible prope as n been physically injured or destroyed.
VV. Protected Information mean ivate lic personal information concerning a person in any format that has
been lawfully collected, stored o main ained by an Insured or Outsourced Service Provider acting at the direction
of the Named Insured. This doe to include records that are lawfully available to the general public for any reason,
including but not limited to information fro tate or local government records.
WW. Qui tam plaintiff means a private plaint' nder the F se Claims Act (31. U.S. Sections 3729-3733).
XX. Regulatory Wrongful Acts means acts omissions ing rise to an Insured Event.
YY. Related Claims means Claims based up arising from, in consequence of, directly or indirectly resulting from, or
involving in any way continuous, repeated, the same, relate or substantially similar facts, circumstances, subjects,
situations, decisions, causes, persons, transactions, even s of persons or events, or a continuous, repeated, the
same, related, or a substantially similar seri s o S. circumstances, subjects, situations, decisions, persons,
transactions, class of persons or events.
ZZ. Related Event means Events based upon, arising from, in con ce of, directly or indirectly resulting from, or
involving in any way the continuous, repeated, the same, r e r substantially similar facts, circumstances,
subjects, situations, decisions, causes, persons, transa ns, ts, classes of persons or events, or a continuous,
repeated, the same, related, or a substantially similar se ies a stances, subjects, situations, decisions,
persons, transactions, class of persons or events.
AAA. Reputation Protection Expense means the reasonable and
a third party to re-establish and restore the Insured's profess
Professional Incident or Sexual Abuse and Molestation.
sary expenses incurred directly by the Insured for
nal reputation 'ch is damaged as a direct result of a
Reputation Protection Expense does not include sums payable
employees.
BBB. Restitution means repayment of fees, reimbursements, profits, c
from:
1. governmental health benefit payor or program,
connection with, any such program; or
2. a Commercial Payor; or
3. any patient;
laim Expenses or salaries for
is received by the Insured
s as part of, or in
to which the Insured was not legally entitled by reason of a billing error or errors, the return of which is. sought
in a Billing Errors Proceeding.
CCC. Sexual Abuse and Molestation means actual or alleged abuse, molestation, mistreatment, maltreatment of a sexual
nature against any person, including, but not limited to, any sexual involvement, sexual conduct, with or without
consent, and negligent hiring, supervision, training, negligent retention and/or investigation of or failure to report to
proper authorities any person who committed or is alleged to have committed any act of sexual abuse and molestation.
EO 13 26 08 20 Page 9 of 18
DDD. Shadow Audit means an audit performed by a qualified professional, which examines the same billing records and
related documents as those subject to an ongoing Billing Errors Proceeding, with the intent of providing the Insured
with a private expert opinion.
EEE. Stark Proceeding means proceedings Instituted against the Insured by a Government Entity alleging violation of
any federal, state or local anti -kickback or self -referral laws.
FFF. Subpoena Assistance means representation and advise for an Insured from us, or an attorney we designate, at any
court hearing, proceeding or government inquiry, and includes assistance in responding to a subpoena, providing
documentation as req a subpoena or providing and preparing testimony required by a subpoena.
GGG. Subpoena E rises can osts incurred by the Company in order to provide the Insured with Subpoena
Assistance.
HHH. Suit means a J 4oceeding in which Damages resulting from a Professional Incident, Sexual Abuse and
Molestation, Network Securit, d Data Privacy Wrongful Act or Media Wrongful Act are alleged. Suit
includes an arbitration proc to hich the Insured is required to submit or to which the Insured has submitted
with our consent.
III. Supervisory Duties in ans the responsibilities required of a Supervising Physician when delegating services to a
Physician's Assistant, Nurse Practitioner Advanced Practice Registered Nurse as governed by the state within
which the Physician's Assistant, Nur ' ioner, Advanced Practice Registered Nurse and Supervising Physician
are practicing.
JJJ. Unauthorized Access or Una horiz s means access to or the use of the Insured's Computer System by a
person or organization that is no authorized to do so, or the access to or use of the Insured's Computer System by
an authorized person in an unauth ed manner.
KKK. Voluntary Self Disclosure means the Ins isc s information, without inquiry, to a Government Entity or
Commercial Payor which may serve as unds for a PAA Proceeding or Billing Errors Proceeding against the
Insured. Such information must have b ome know the Insured fortuitously and subsequent to the inception of
this Policy.
SECTION V. INCIDENT REPORTING PROVISIO
If during the Policy Period, you first become aware of any is a d identifiable Professional Incident, Sexual Abuse
and Molestation, Network Security and Data Pri rongful Act or Media Wrongful Act and during the Policy
Period you give written notice to us of:
A. The specific Professional Incident, Sexual Abuse an station, Network Security and Data Privacy
Wrongful Act or Media Wrongful Act includi t at and parties involved; and
B. The Damages which have or may result from su h P ession cident, Sexual Abuse and Molestation,
Network Security and Data Privacy Wrongful Ac is ful Act; and
C. The circumstances by which you first became awa ch Professional Incident, Sexual Abuse and
Molestation, Network Security and Data Privacy Wr gful Act or Me is Wrongful Act.
For the purposes of this insurance, a Professional Incident, Sexual Abuse an tion, Network Security and Data
Privacy Wrongful Act or Media Wrongful Act reported under this ro hall b eemed a Claim.
SECTION VI. POLICY EXCLUSIONS
1. EXCLUSIONS APPLICABLE TO ALL INSURING AGREEMENTS
We shall not be liable to defend, pay, indemnify or reimburse the Insured with respe any Claim or Event, based
upon, resulting from, arising out of, in consequence of, or in any way in connection or olving, directly or indirectly:
A. Prior Knowledge
1. Any actual or alleged Claim, Event, fact, circumstance, subject, decision,t ion, situation or cause which
has been reported, noticed or identified to any other insurance carrier, third administrator or claims handler
under any other insurance policy, application or agreement.
2. Any actual or alleged Claim or, Event, fact, circumstance, subject, decision, transaction, situation or cause of
which the person signing the Application for this Policy or any of the Insured's current, former or future director,
Chief Executive Officer, Chief Medical Officer, Chief Operating Officer, Chief Financial Officer, Chief
Technology Officer, Chief Privacy Officer, President, or equivalent position was aware prior to the effective date
of this Policy or any other Policy issued by us if such Claim, Event, fact, circumstance, subject, decision,
transaction, event, situation or cause could reasonably have been expected to give rise to a Claim or Event.
EO 13 26 08 20 Page 10 of 18
3. Any actual or alleged Claim or Event committed or which took place in whole or in part before the retroactive
date shown on the Declarations.
4. Any prior or pending litigation, Claim, Event, fact, circumstance, subject, decision, transaction, situation, cause,
proceeding or investigation made, presented, transmitted, filed or commenced on or before the effective date of
this Policy, or alleging or derived from the same litigation, Claim, or Event, fact, circumstance, subject, decision,
transaction, situation, cause, proceeding or investigation underlying or alleged therein.
B. Insured versus Insured
A Claim brought by n b alf of:
1. an Insu agai an er Insured, however this exclusion shall not apply to an otherwise covered Claim
made agai st an Insured by another Insured for Professional Services rendered to another Insured in their
capacity as t or patient of any Insured or the Named Insured;
2. any entity which is ownedtrolled by or is under common ownership or control of the Insured;
3. any person or en ' 01 own r controls any entity included within the definition of Insured;
4. any entity of whic the Ins is a director, officer, partner or principal shareholder.
C. Intentional Acts
1. Any actual or alleged dishone ud ent, criminal, malicious or intentional act, error, or omission by an
Insured, however, this e es no pply to Claim Expenses incurred in defending any such Claim until
such time as there is a fi adju bion, judgment, binding arbitration, or conviction of any Insured, or an
admission of such conduct the Insured. This exclusion does not apply to those Insureds who did not
intentionally and knowingly mit, acquiesce or participate in this conduct.
.2. The execution, creation, or commissi a ured, of a denial of service attack or the execution, creation
or commission of Malicious Code ch limits or revents the use of the Insured's Computer System or any
third party's computer system or ne ork, howev is exclusion does not apply to Claim Expenses incurred in
defending any such Claim until such 'me as there is a final adjudication, judgment, binding arbitration, decision
or conviction of any Insured, or an adm'ion of such cc4aduct by the Insured. This exclusion does not apply to
RL
those Insureds who did not intentionally and knowin mmit, acquiesce or participate in this conduct.
3. Any actual or alleged gaining of any profit r a ge to which the Insured is not legally entitled, however this
exclusion does not apply to Claim Expense cuffed in defe ding any such Claim until such time as there is a
final adjudication, judgment, binding arbitrate n, decision or viction of any Insured, or an admission of such
conduct by the Insured. This exclusion does not apply t nsureds who did not intentionally and knowingly
commit, acquiesce or participate in this conduct.
D. Direct Patient Care
Direct Patient Care provided by any Medical Director.
In
F.
Supervisory Duties
Supervisory Duties provided by any Medical Director.
Under the Influence of Intoxicants or Narcotics
Any Professional Incident taking place in whole or in part while y Ins is under the influence of intoxicants
or narcotics. This exclusion does not apply to the Named Insured any Insured -who was not under the influence
of intoxicants or narcotics and did not know or have reason to believ at any Insur was under the influence of
intoxicants or narcotics.
G. Discrimination
1.
Any actual or alleged unlawful discrimination of any kind, based o:
ethnic background, national origin, age, handicap, sex, sexual c
information, marital status or financial condition.
race, creed, religion,
dentification, genetic
2. Any actual or alleged wrongful employment practice including but not limited to any refusal to employ,
termination of employment, employment policies or procedures, coercion, demotion, evaluation, retaliation,
reassignment, discipline, defamation, harassment, humiliation, failure to promote, wrongful disciplinary action,
deprivation of career opportunity, inadequate work place, whistle -blowing, and labor disputes for any reason.
EO 13 26 08 20 Page 11 of 18
H. Government Enforcement
Any seizure, nationalization, confiscation, destruction, deletion or other malicious or harmful conduct, action or
inaction by or on behalf of or in the name or right of any local, state, federal, or foreign administrative, governmental,
quasi -governmental, regulatory or governmentally approved agency, tribunal, body, person or similar or equivalent
entity of any Protected Information or computer, hardware, software or electronic system held or used by the
Insured.
I. Governmental Actions
J.
IN
Any federal, state, to or eign administrative, governmental, or regulatory agency, tribunal, body or similar or
equivalent ent' ho er, '� exclusion shall not apply as respects an otherwise covered Regulatory Wrongful
Act.
Outside Activiti
Any activities by any Insured er, sole proprietor, superintendent, executive officer, director, partner, trustee or
employee of any organiza ' ich not shown as a Named Insured on this Policy.
Pollution
Any presence, discharge, dispersal, releaselor escape of smoke, vapors, soot, fumes, acids, alkalis, toxic chemicals,
liquids or gases, oil or other petroleu tances or derivatives, waste materials or other irritants, contaminants,
pollutants or any other substances ing a estos, fungus, mold and lead, which are or may be injurious to public
health, property or the enviro (" zard substances") into or upon land, the atmosphere or any water course
or body of water.
It is further agreed that this Polic s not apply to any liability including expenses for:
1. the cost of cleanup or removal of "haz nces
2. the cost of such actions as may be essary to in nitor, assess or evaluate, the presence, discharge, dispersal,
escape, release, or threat of same, o hazardouss.. stances";
3. the cost of disposal of "hazardous bstances" or the taking of such other action as may be necessary to
temporarily or permanently prevent, minimize, or mitig damage to the public health or welfare or to property
or the environment, which may otherwise result; or
4. any cost, based upon, arising from, in con e of, directly or indirectly resulting from, or involving in any
way any government direction or request t t the Insured to ° t for, monitor, clean up, remove, contain, treat,
detoxify or neutralize "hazardous substances". _�O#
L. Workers' Compensation and Employers' Liability
Any Claim for which you or any carrier as your inn:
Unemployment Compensation, Disability Benefits Law,
as amended, or under any similar law or regulation; or to
any employee or former employee of any Insured arising
M. Intellectual Property
Any misappropriation, infringement, or use of a copyright, title,
service mark, domain name, trade secret or any violation of ai
exclusion does not apply to infringement of copyright, trademark,
or service name as a result of your Media Activities.
N. Antitrust
b ' ble, under any Workers' Compensation,
r ' •ement Income Security Act of 1974 and
ickness, disease or death resulting there from of
in the coure of his employment by any Insured.
t demark, trade -name, trade dress,
AW
pr5perty right or law, however this
trade name, trade dress, service mark
Any actual or alleged antitrust, restraint of trade, unfair, false or deceptive 1
state, local or foreign legislation, regulation or law involving or prohibitin any ;
discrimination, monopoly or monopolization, predatory pricing, unfair competit'
false, misleading or deceptive trade or business practice.
O. False Advertisement
, orViolation of any federal,
�Oftity, price fixing, price
usion, conspiracy or unfair,
Any actual or alleged inaccurate, false, misleading, deceptive or fraudulent description, representation or promotion
of the products, services or business of the Insured.
P. Property Damage and Personal Injury
Any Property Damage or Personal Injury, however, we will reimburse the Named Insured for Patient Property
Damage sustained while your patient is receiving Professional Services from an Insured provided that:
EO 13 26 08 20 Page 12 of 18
1. The Patient Property Damage occurs during the Policy Period; and
2. You report the Patient Property Damage to us as soon as practicable during the Policy Period or any Extended
Reporting Period we provide as described in SECTION IX. EXTENDED REPORTING PERIOD.
The Limit of Liability for Patient Property Damage shown on the Declarations is the most we will pay for Patient
Property Damage and no deductible shall apply.
Q. Peer Review
Any Peer Review servi vided by one Insured for another Insured, however we will reimburse the Insured for
amounts incurred in t efe e of an allegation of negligent Peer Review but subject to the Limit of Liability for Peer
Review show n the ecln ons, and no deductible shall apply.
R. Contractual Li ili
Liability you assume under any c ract or agreement, however this exclusion does not apply to liability you would
have in the absence of such c agreement.
S. Pricing, Guarantees a ti s
Any Claim alleging an Insure exceeded a contract price, cost guarantee or cost estimate.
T. Natural Disaster
Any fire, flood, earthquake, volca ' ptio explosion, lightning, wind, hail, tidal wave, landslide, or other act of
God.
U. Unauthorized Data Collection
Any unlawful, unauthorized or un sclosed obtaining, gathering, collecting, acquiring, using, distribution or sale of
any information of any type, nature or ki I sured, including but not limited to Protected Information
however, this exclusion does not apply t y Insure ho did not intentionally and knowingly commit, acquiesce
or participate in this conduct or in the a nce of a fin k adgment, adjudication or binding arbitration ruling adverse
to such Insured.
V. Uninsurable Amounts
Any amounts which are or may be deemed uninsurable law under which this Policy is construed.
W. Unsolicited Communication
The unsolicited dissemination of any communica 'on to actual or spective customers of the Insured or any third
party, including, but not limited to, actions brought under th one Consumer Protection Act, the CAN -SPAM
Act, or any other federal, state or local legislation, reg 1 ' o protecting a person's or entity's right of seclusion
or privacy; however, this exclusion does not apply to two ecurityand Data Privacy Wrongful Acts.
X. Securities Violation
Mid
H
Any actual or alleged violation of any federal, state, local o securities -related legislation, regulation or law.
Sanctions
Any economic or trade sanction imposed by the United States, includ' no imited to, sanctions administered
and enforced by The United States Treasury Department's Office ei Asse Control ("OFAC").
Sexual Abuse
Any actual or alleged sexual abuse, sexual molestation, sexual adva or sexual m conduct or any behavior or
communications intended to lead to, or culminating in sexual abuse, sexual moles , sexual advances or sexual
misconduct, however, this exclusion shall not apply to a Claim for otherwise co mole
ual Abuse and Molestation.
AA. Restitution
Any amounts which are intended to serve as Restitution or repayment o:
any Insured was not entitled, as a result of billing errors made by the Inst
BB. Billing Errors
the Insured to which
Costs, Charges and Expenses, Audit Expenses or Fines and Penalties incurred in any Billing Errors Proceeding
involving billing errors for medical services or items which are not provided or prescribed by the Insured.
2. EXCLUSIONS APPLICABLE ONLY TO NETWORK SECURITY AND DATA PRIVACY LIABILITY
We shall not be liable to defend, pay, indemnify or reimburse the Insured with respect to any Claim or Event, based
upon, resulting from, arising out of, in consequence of, or in any way in connection with or involving, directly or indirectly:
EO 13 26 08 20 Page 13 of 18
A. Bodily Injury and Property Damage
Any actual or alleged:
1. Bodily Injury; however, this exclusion does not apply to Bodily Injury sustained by a natural personas a direct
result of a Network Security and Data Privacy Wrongful Act;
2. Property Damage.
B. Mechanical Failure
Any electrical or me failures, including power interruption, surge, brownout or blackout, or defect of
telephone, telec m atio or data transmission lines, services, equipment or infrastructure.
SECTION VII. LIMIT * OF I ITY AND DEDUCTIBLE
ray
C.
D
The Limit of L i as shown oin the Declarations and the rules detailed below fix the maximum amount we are
obligated to pay for all Dam 3, each Claim or Related Claim under this Policy, as detailed in SECTION I.
INSURING AGREEMEN e 'mits of Liability shall be subject to the Aggregate Limit as shown on the
Declarations for each a d shall be part of, and not in addition to, the Policy Aggregate shown on the
Declarations.
The Additional Coverage Limits of Liabili shown on the Declarations and the rules detailed below fix the maximum
amount we are obligated to pay for al nal Coverages under this Policy, as detailed in the applicable Insuring
Agreement in SECTION II. D AL VERAGE INSURING AGREEMENTS. The Additional Coverage
Limits of Liability shall be pa , and in dition to, the Policy Aggregate shown on the Declarations.
The Policy Aggregate Limit sho n on the Declarations is the most we will pay under this Policy for all Claims or
Events and once the Policy Aggr e ha.s been exhausted there will be no fiirther duty to defend the Insured or to
pay on behalf of or reimburse any Insured 'ms or Events.
Applicable rules to the Limits of Liabili
1. The applicable Limit of Liability st d in the Declarations is the maximum we will pay regardless of the number
of Insureds, individuals or organizat s that make a Claim, or the number of Events.
2. Our duty to defend will end when our Limits of Liabili ve been exhausted by payment of Damages, Claims
Expenses, Privacy Breach Expenses, Costs, Ch an 'Expenses, License Defense Costs, Subpoena
Expenses, Reputation Protection Expens ve been deposited with a court of competent jurisdiction.
3. If any of the Limits of Liability shown on the eclarations sh NIL, that portion of this Policy is not applicable
and no coverage shall apply for the corresponding insuri ement(s).
E. Claim Expenses
We will pay Claim Expenses with respect to any Claim
AM
Unless modified by Endorsement, these payments will no r
the Claim Expenses Aggregate Limit shown on the Declarati
then Claim Expenses will reduce the applicable Limit of Li
F. PL Deductible
1.
The PL Deductible shown on the Declarations applies separa
Insured. The PL Deductible applies to covered Claim Expe e�
part or all of the PL Deductible amount and upon notification o
must promptly reimburse the Company for the PL Deductible am
of this Policy apply in excess of the PL Deductible.
2. Mediation of a Claim
red that we defend, investigate or settle.
pli able Limit of Liability, but are subject to
Claim Expenses Aggregate Limit is exhausted;
and shall be paid by the Named
We may advance payment of
eiiag made, the Named Insured
us. The Limits of Liability
If Mediation is used as a means to resolve a Claim made against the Inuur to ch this insurance applies,
and such Claim is resolved solely, directly and immediately by the Mediati0 1 n the PL Deductible obligation
of the Named Insured shall be reduced by 50% subject to a maximum redu ton of $25,000. We shall reimburse
the Named Insured 50% of any portion of the PL Deductible payment made to us by the Named Insured prior
to the Mediation as soon as practicable after the conclusion of the Mediation.
G. Multiple Claims, Events, Professional Incidents
The inclusion herein of more than one Insured or the making of Related Claims or Related Events by more than
one person or organization shall not operate to increase the Company's Limit of Liability. For purposes of this
insurance, all Claims for Damages or Claim Expenses directly or indirectly arising out of a single Professional
EO 13 26 08 20 Page 14 of 18
Incident, Sexual Abuse and Molestation, Network Security and Data Privacy Wrongful Act, Media Wrongful
Act or Event that are logically or causally connected shall be treated as a single Claim or a single Event. All such
Related Claims and Related Events, whenever made, shall be considered first made and reported to the Company
during the Policy Period in which the first of all such Claims or Events was first made against any Insured or
reported to the Company. All Related Claims or Related Events arising out of a single Professional Incident,
Sexual Abuse and Molestation, Network Security and Data Privacy Wrongful Act, Media Wrongful Act or
Event or logically or causally connected Professional Incident(s), Sexual Abuse and Molestation, Network
Security and Data Priv, 'Wrongful Act(s), Media Wrongful Act(s) or Event(s) shall be deemed to constitute a
single Claim or singl en nd be subject to the same Limit of Liability — Each Claim/Event, as stated in the
Declarations.
SECTION VIII. OT CO IT ONS
A. Transfer of Rig h ecovery
If there is a payment madeby e all be subrogated to all of the Insured's rights of recovery against any person
Or organization. The In. will c perate with us and do whatever is necessary to secure these rights. You must
not waive or prejudice c ri
B. How Other Insurance Applies
This insurance shall be excess of and o tribute with Other Insurance, whether collectible or not, that affords
coverage for a Claim or Ev of
t for her Insurance that is written specifically to apply in excess of the
applicable Limit of Liability o s Pol
This insurance shall be excess any Claim or Event to the extent it is insured under any other existing insurance
whether such Other Insurance J ated to be primary, contributory, excess, contingent or otherwise, except for
amounts incurred by the Insured which n or equal to the Insured's deductible under such Other
Insurance, and which do not exceed the ximum A ount Reimbursable or the applicable Limit of Liability of
this Policy.
If a Policy issued by us and one or mor olicies issued by another insurer apply to the same Claim or Event, our
pro -rata share will be determined by the to imits of Liabi 'ty of our Policy in effect at the time the first Claim or
Event was made and reported to us in writing and the Li Liability of all Other Insurance.
C. Changes Made to this Policy
The terms and conditions of this Policy cannot b waived or chan d except by specific written endorsement issued
by us and made part of the Policy.
D. Assignment of the Insured's Interest
The interest of the Insured under this Policy is not as ign to an er person or organization, except with the
Company's prior written consent.
E. Bankruptcy
Bankruptcy or insolvency of the Insured or the Insured's es ate shall not reli e us of any of our obligations under
this Policy.
F. Cancellation
This Policy may be canceled by the Named Insured by returning e Poli to us or our authorized representatives.
The Named Insured can also cancel this Policy by written notice to ating at wha uture date cancellation is to
be effective. If the Named Insured cancels, earned premium shall be computed usin e customary short rate table
or the amount stated elsewhere in this Policy as Minimum Earned Premium, whir s greater.
We can cancel the Policy by written notice to the Named Insured, at the rad
ss 1 ow to us. We will provide
written notice at least thirty (30) days before cancellation is to be effective the mre ium will be computed
pro -rata. However, if we cancel because you fail to pay a premium or PL Ded when due, only ten (10) days
written notice of cancellation will be given and earned premium will be compute sing the customary short rate table.
The mailing of any notice of cancellation shall be sufficient proof of notice.
This Policy will terminate on the effective date of the cancellation. Return of unearned premium is not a condition of
cancellation. Unearned premium will be returned by us as soon as practicable.
G. Application
The statements made in the Application are all Insureds' representations and are deemed material. This Policy is
issued based upon the truth and accuracy of such representations.
EO 13 26 08 20 Page 15 of 18
H. Audit
I.
J.
K.
L.
M.
91
We may examine and audit your books and records at any time during the Policy Period and within three (3) years
after the expiration or termination date of this Policy, as far as they relate to this Policy.
Action Against Us
No action shall be brought against us by any Insured, unless, as a condition precedent thereto:
1. all Insureds have fully complied with all the terms and conditions of this Policy; and
2. the amount of Da as been fixed or rendered certain;
a. by fi ud nt a st the Insured after trial of the issues; or
b. the ti e to eal such judgment has expired without an appeal being taken; or
c. if appea aken, after th ppeal has been determined; or
d. the Claim is settled ' o ance with the terms and conditions of the Policy.
In no event shall any u anyone be maintained against us unless such action is brought within twenty-
four (24) months from e time fight to bring action first became available.
False or Fraudulent Claims
If an Insured reports any Claim kn su Claim to be false or fraudulent, this Policy shall become void and all
insurance coverage hereunde e rfeite s of the inception date of this Policy.
Terms and Conditions of Polic onfo ed to Statute
Where necessary, the terms and cd�itions of this Policy will be amended to conform to applicable law.
o
Stacking of Limits
Under no circumstances shall more than e Insuring reement apply to any Claim or Event under this Policy. In
the event that more than one Insuring A eement is a ed to apply to a Claim or Event, we shall have the right to
designate which Insuring Agreement sh apply and we shall not pay more than the highest applicable Limit of
Liability for the Insuring Agreement we desi te.
Change in Controlling Interest
If, during the Policy Period:
1. a Named Insured merges into or consolida es with anothe ntity such that the Named Insured is not the
surviving entity;
2. another person or entity acquires the Named Ins Aw'Vr
3. another person or entity acquires a controlling interest ' sured; or
4. there is a divestiture or sale of more than fifty percent (50% amed Insured's assets and/or liabilities;
then the coverage under this Policy will continue for the Na d Insured, but my for Claims or Events that occur
before the date of such Change in Controlling Interest described above. T ' 1 apply unless you notify us within
thirty (30) days of such Change in Controlling Interest and we issue an sem t stating otherwise.
Premium
The premium amount for this Policy is stated in the Declarations an is for coverage for the Policy Period. If during
the Policy Period there is a change in coverage afforded, we have th ght to adjust premium as of the date of
change. Any premium adjustment shall be made in accordance with our prevailing and rates.
Premium shown as advance premium is a minimum and deposit premium
compute the earned premium for that period. Audit premiums are due
Insured.
If the premium for this Policy is a flat premium, it is not subject to adjustn
O. Minimum Retained Premium
i audit period we will
e to the first Named
In the event of cancellation of this Policy by the Named Insured as specified herein, return premium shall be
computed at .90 (Ninety percent) of the pro rata unearned Policy premium (or minimum premium if applicable) subject
however to a retention by the Company of not less than twenty-five (25%) of the premium shown on the Declarations
or renewal certificate.
EO 13 26 08 20 Page 16 of 18
It is further agreed that return premium may be allowed on a pro rata basis if cancelled for non-payment, subject
however to retention by the Company of the minimum premium as shown above.
SECTION IX. EXTENDED REPORTING PERIOD
As a condition precedent to your right to obtain an Automatic Extended Reporting Period (AERP) or an Extended
Reporting Period (ERP), the full premium of this Policy, premium for endorsements or audits, and payment of deductibles
must have been paid in full. Neither the AERP nor the ERP reinstate or increase the Limits of Liability. Neither the AERP
nor the ERP extend the Policy Period or change the scope of coverage afforded by this Policy.
A. Automatic Extended orti Period (AERP)
If we or you cel on- ew this Policy for any reason other than non-payment of premium, non-payment of
deductible, no com nce with any terms and conditions of this Policy, fraud or material misrepresentation then you
shall be entitle utomatic E tended Reporting Period (AERP) period of (60) sixty days from the date of Policy
expiration or cancellation to repo aims or Events in writing to us which are first made against the Insured during
the Policy Period and aris of covered Professional Incident, Sexual Abuse and Molestation, Network
Security and Data ro 1 Act, Media Wrongful Act or Event which takes place subsequent to the
retroactive date shown the De ions and prior to the Policy expiration or cancellation date. If the ERP in section
B. below is purchased then this AERP shal be included within such ERP.
ML
B. Extended Reporting Period (ERP)
If we or you cancel or non -r i olicy r any reason other than non-payment of premium, non-payment of
deductible, non-compliance wi any to man conditions of this Policy, fraud or material misrepresentation then you
shall be entitled to purchase an RP from the options below which begin from the date of Policy expiration or
cancellation. to report Claims or nts in writing to us which are first made against the Insured during the Policy
Period or ERP and arise out of a Professi nt, Sexual Abuse and Molestation, Network Security and
Data Privacy Wrongful Act, Media W gful Act Event which take place subsequent to the retroactive date
shown in the Declarations and prior to tl olicy expir n or cancellation date.
1. ERP Options
a. One year for a premium not to excee 125% of the nual premium,
b. Two years for a premium not to exceed 1500 a ual premium, or
c. Three years for a premium not to exce /o of the annual premium.
2. Your right to purchase the ERP must be exerc sed by notice ' iting to us no later than thirty days (30) after the
expiration or cancellation date of this Policy and must ' payment of premium for the ERP. Upon receipt
of the written notice to us and the premium for t entire premium is deemed fully earned and is non-
refundable.
SECTION X. REPORTING OF CLAIMS, EVENTS AND INC
1.
2.
PO Box 5430
Mt. Laurel, NJ 08054
admclaimsgadmiralins.com
If the Insured becomes aware of a Claim or Event that first takes place during tiffolicy Period and may be covered
by this Policy, the Insured must provide written notice to us as soon as practicable, but in no event later than the
expiration date of the Policy or any applicable Extended Reporting Period. The Insured must immediately send
copies to the Company of any demands, notices, or legal papers received and must authorize the Company to obtain
records and any other related information.
3. If the Insured becomes aware of a Privacy Breach Event that first takes place during the Policy Period and may be
covered by this Policy, the Insured must provide written notice of such Privacy Breach Event to the Insurer as soon
EO 13 26 08 20 Page 17 of 18
as practicable, but in no event later than the expiration date of the Policy or AERP, or no longer than the minimum
time period required by the applicable Privacy Law.
A. The Insured must immediately send copies to the Company of any demands, notices, or legal papers received in
connection with any Privacy Breach Event, and must authorize the company to obtain records and any other
information related to the Privacy Breach Event.
B. An Event Hotline is available for consultation at your sole expense, unless the Company has otherwise agreed to
pay for such consultation and your Policy shall include an endorsement or notice of the particulars for contacting
the Event Hotline
4. All Insureds fu assi nd cooperate with us in the conduct, defense, investigation, negotiation and settlement
of any Claim o Eve t ur request, the Insured must submit to an examination under oath; provide us with written
statements as r by us, and attend meetings and negotiations; produce and make available all information,
records, documents and other mat is which we deem relevant to the Claim or Event.
5. All notices of Claims, Eve nci nts, must provide the following information: the potential claimant(s) by name
or description, the na Ins ds involved, the time, date, location and the description of the specific incident
which forms the basis the , Event or Incident including the nature of the potential Damages arising from
such specific Claim or Incident, the circumstances by which the Insured first became aware of the specific Claim,
Event or Incident; and the reason the I d reasonably believes the specific incident is likely to trigger coverage
under this Policy.
6. As respects any Claim or Eve ie I d ust attend hearings, depositions, proceedings, trials and appeals; and
assist us in affecting settlements, ecuri g and giving evidence and obtaining the attendance of witnesses, and pursing
or enforcing any right of contribu nor indemnity against a person or entity who may be liable to any Insured.
7. No Insured will, except at its own cost, vo + ke a payment, admit liability, settle a Claim, settle an Event,
retain attorneys, consultants, or related v ors, or ass e any other obligation or incur any other expense without
the Company's prior written consent.
8. Immediately send the Company copies all demands, notices, summonses or legal papers received in connection
with the Claim, or Event. The Insured in °o whatever is ecessary to secure and effect any rights of indemnity,
contribution or apportionment that the Insured may have Insured shall accept our assignment of counsel and
the Insured shall refrain from discussing any Clai ent with anyone other than counsel retained to represent
the Insured or our representatives. A.
JL
EO 13 26 08 20 Page 18 of 18
Policy Number:
EO 13 27 0816
Effective Date:
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY,
DESIGNATED LOCATION ENDORSEMENT
This endorsement modifies insurance provided under the following:
PROFESSIONAL LIABILITY COVERAGE PART
In consideration of the premium charged, it is agreed that the coverage provided by this Policy does not apply to a Profes-
sional Incident or Sexual Abuse and Molestation arising from Professional Services rendered anywhere other than the
below designated location(s):
DESIGNATED LOCATION
840 E. Plum St.,, Moses Lake, WA 98837
All other terms and conditions of the Policy remain unchanged and apply.
EO 13 27 08 16 Page 1 of 1 0
Policy Number:
EO 13 30 05 20
Effective Date:
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
In consideration of the premium charged, it i d t this Policy does not apply to any Claim or Claim Expenses in
connection with, directly related to or of Pr ssional Services rendered to patients who come under the care of
an Insured while they are residents of ursin m or Assisted Living Facility whether or not such Professional
Services are rendered within the physica cation of a Nursing Home or Assisted Living Facility.
It is further agreed that for any Claim which is ex c under e terms of this endorsement, the Company shall not have the
obligation to defend, adjust, investigate or pay a cost for inv 'gation, defense, adjustment or attorney fees arising out of
such Claim.
All other terms and conditions of this Policy remain unchanged an
EO 13 30 05 20 Page 1 of 1 13
Policy Number:
EO 13 36 08 16
Effective Date:
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY,
SPECIFIED OPERATIONS EXCLUSION (ABSOLUTE)
This endorsement modifies insurance provided under the following:
PROFESSIONAL LIABILITY COVERAGE PART
It is agreed that the insurance afforded by this policy does not apply to any Claim or Event based upon or arising out of, di-
rectly or indirectly, in whole or in part,
surgery and/or assist in surgery;
pre -natal care and/or obstetrics;
services to correctional facilities including but not limited to jails, prisons, detention centers
conducted by or for the Named Insured.
It is further agreed that for any Claim which is excluded under the terms of this endorsement, the Company shall have no
obligation to defend, adjust, investigate or pay any cost for defense, adjustment, investigation or attorney fees arising out of
such Claims.
All other terms and conditions of the Policy remain unchanged and apply.
EO 13 36 0816 Page 1 of 1 13
Policy Number:
EO 13 39 08 16
Effective Date:
41
This Policy does not apply to any Claim or Event ' ing, directly or indirectly, out of an Act of Terrorism.
With respect to this endorsement only, Act rori means activities against persons, organizations or property of any
nature:
a. That involve the following or p Event
n for the following:
(1) Use or threat of force or viole ; or
(2) Commission or threat of a dangerous
(3) Commission or threat of an act that ' erferes with disrupts an electronic, communication, information, or
mechanical system; and
b. When one or both of the following applies.
(1) The effect is to intimidate or coerce a government or ilian population or any segment thereof, or to dis-
rupt any segment of the economy; or
(2) It appears that the intent is to intimidate or c e a governme .t, or to further political, ideological, religious,
social or economic objectives or to express (o express oppo ' to) a philosophy or ideology.
For any Claim which is excluded under the terms of this endorsem ompany shall not have the obligation to defend,
adjust, investigate or pay any cost for investigation, defense, a me r attorney fees arising out of such Claim.
All other terms and conditions of the Policy remain unchanged an
EO 13 39 0816 - Page 1 of 1 13
Policy Number:
EO 14 12 07 21
Effective Date:
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
SPEqrF"kD TREATMENT EXCLUSION
All other terms and conditions of this Policy remain uchanged and ajVly
EO 14 12 07 21 Page 1 of 1 13
Policy Number:
Al 44 02 08 21
Effective Date:
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
SERVICE OF SUIT
Pursuant to any statute of any state, to r district of the United States which makes provision therefore, the Company
hereby designates the Superin end ommioner or Director of Insurance or other Officer specified for that purpose in the
Statute, or his/her successor or esso ice, as its true and lawful attorney upon whom may be served any lawful process
in any action, suit or proceeding instituted by or on behalf of you or any beneficiary hereunder arising out of this contract of
insurance, and hereby designates the below named the person to whom the said Officer is authorized to mail such process
or a true copy thereof.
It is further agreed that service of proc suc u't be made upon John Briggs, or his nominee of the Company at 7233
East Butherus Drive, Scottsdale, Arizon 85264, and that in any suit instituted against the Company upon this policy, it will
abide by the final decision of such Court o ny Appellate Court in the event of an appeal. Nothing herein shall constitute a
selection or designation of forum, or a waiver of any o, mpany's rights to select a forum or court, including any of the
federal courts of the United States. This includes g t to mmence an action in or remove or transfer an action to the
United States District Court or any other court of petent juri iction, as permitted by law.
Further, pursuant to any statute of any state, territ or district of the United States of America or province of Canada, which
makes provision therefore, we hereby designate the u rintendent, C missioner or Director of Insurance or other officer
specified for that purpose in the statute, or his successor or succes office, as our true and lawful attorney upon whom
may be served any lawful process in any action, suit or proce instituted by you or on your behalf or any beneficiary
hereunder arising out of this contract of insurance, and w e y designate the above named as the person to whom the said
officer is authorized to mail such process or a true copy th eof.
Al 44 02 08 21 Page 1 of 1 13
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As an Admiral Policyholder, yc
Event Hotline dedicated to Ad
Mullen Coughlin, LLC is a law firm dedu'
and risks. Having handled thousandsv
talent in pre -breach planning and comb
reac
1
to receive data breach coach services by Mullen Coughlin, LLC via an
Lto sol ltv servicing organizations with data privacy crises, incidents,
)o�herr accessible and motivated attorneys possess experience and
e, breach response, regulatory investigation and management, and
privacy litigation defense unmatched in PTeindustry.
Should you experL will Ince rivacy
Mullen Coughlin,4 grovide
Breach Event,
the following,
1. 24/7 Data Breach Hotline: 1(844)572-2113miralbreachhotline (amullen.law
"r 1
2. Up to 60 minutes of free data breach consruling and/or advisory services following a discovery of a
Privacy Breach Event or possible Privacy Breach is the Data Breach Hotline.
L
*Please be aware that the Hotline service is provided by a thi rte. If you engage this service, it is
billable to you at the standard rate per hour outlined in the Ad nel Vendor Guidelines. Admiral is not a party
to any agreement entered into between Mullen Coughlin, LLC d the Policyh Ider. Conversations between
Mullen Coughlin and the Policyholder are subject to attorney-client privile
When contacting the Hotline, please have the following information adil ailable, if possible:
1. Full name of the Insured Organization I
2. Admiral Policy number of the Insured Organization
3. The name and phone number of the individual authorized to discus
This additional service does not affect or change the terms or conditions ojPTirs- Policy. If you discover or
believe you have sustained a Privacy Breach Event as defined in this Policy, please separately notify the
Admiral Claims Department immediately, per the conditions set forth in this Policy.
For more information about the services provided by Mullen Coughlin, please contact your Admiral Representative.
Please Note: The above -referenced data breach services are provided on a gratis basis to Admiral Policyholders and no premium has been
charged for these services. Mullen Coughlin, LLC is not an employee, partner, or agent of Admiral. Admiral bears no responsibility, either directly
or vicariously for any services provided by Mullen Coughlin,, LLC.
MKO1220619