HomeMy WebLinkAbout07040070 Certificate of Insurance
American Massage Therapy Association@
Certificate of Insurance
Member ill: 3563
Mark C. Henderson
3901 Shelborne Ct
Carmel, IN 46032-9529
Member Classification: PROF W
Member Effective Date: 03/0112007 to 02/29/2008
Administered By:
Healthcare Providers Service Organization
Affinity Insurance Services, Inc.
159 East County Line Road
Hatboro, PA 19040-1218
Insurance Company:
American Casualty Company of Reading, P A
j,T"'e;ofiffisurance~:I,'lii;\iiMasreriPoIic";iNiiIDtiei!'ii,}Master<pOIi"]Effectivii!Date~~'j!UiiiitS!'erienl'olleaimeiiiller)~
Professional Liability N 0289955556 lIl/200? 12:01 AM Standard Time $2,000,000 each claim /
Occurrence Coverage to 1/1/2008 12:01 AM Standard $6,000,000 aggregate Subject to
Time the Master Polk A e ate
Coverage is afforded to Enrolled Members for a period of 12 months concurrent with the Enrolled Member's effective date or
until membership is terminated or expires. If the Master Policy is non-renewed or cancelled, the Enrolled Member's coverage
under this policy will terminate upon the expiration of the Certificate Period and will not be renewed. The Master Policy
A re ate ma be reduced b claims aid on behalf of other insureds.
Additional Coverages (included in Professional Liability Limits specified above):
. Personal Injury Liability
. Good Samaritan Liability
. Malplacement Liability
. Workplace Liability
. Fire & Water Legal Liability (subject to $250,000 sub limit)
Coverage Extensions
License Protection
Defendant Expense Benefit
Deposition Representation
Assault (excluding Texas)
Medical Payments
First Aid
Damage to Property of Others
Coverage Extension Limits
$10,000 per proceeding / $25,000 aggregate
$10,000 aggregate
$2,500 per deposition / $5,000 aggregate
$10,000 per incident / $25,000 aggregate
$2,000 per person / $100,000 aggregate
$2,500 aggregate
$500 per incident / $10,000 aggregate
This material is intended to provide a general overview of the products and services offered. Only the policy can provide the actual terms,
coverage's, amounts, conditions and exclusions. Please contact HPSO at 1-888-253-1474 directly for a copy of the complete policy.
_HPSO
Actt 8 0 .~ 7 5 7 STATE OF FLORIDA
DEPARTMENT OFHEAL TH
DIVISION OF MEDICAL QUALITY ASSURANCE
.. .
DATE LICENSE NO. CONTROL NO.
0811712005 MA 5328 67707
The MASSAGE THERAPIST
named below has met all requirements of
the laws and rules of the state of Florida.
ExpirationDate: AUGUST 31, 2007
MARK CHARLES HENDERSON
3901 SHELLBORNE CT
CARMEL, IN 46032
2.- -C- /T-
JEB BUSH.
GOVERNOR
--
~
JO~WUNOBI, M.D.; M.P.H., M.BA
SECRETARY
DISPLAY IF REQUIRED BY LAW
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