2b. Jail contracted psychiatry services-malpractice insurance

Proposal of Insurance For Naveed Haider, M.D. Page 8 of 16 Coverage Highlights: Medical Malpractice Coverage: Medical Malpractice Carrier: Kinsale Insurance Company Policy Period: Effective from 11/01/2016 to 11/01/2017 standard time at the address of the named insured. The insurance company with which this coverage has been placed is not licensed by the State of North Carolina and is not subject to its supervision. In the event of the insolvency of the insurance company, losses under this policy will not be paid by any State insurance guaranty or solvency fund. The following is a general summary of the Insuring Agreement. Refer to actual policy form for complete terms and conditions. This policy is provided on a claims made basis subject to the retroactive and/or pending or Prior acts date. Should you elect to change carriers (if a new retro-active date is provided) or non-renew this policy, a supplemental extended reporting endorsement may be available subject to policy terms and conditions. Please refer to attached Policy Form for terms and conditions. Form Type: Coverage Form Type Retroactive Date Medical Malpractice Claims Made 11/01/2016 Medical Malpractice Descriptions: Coverage Item Description Specialty Psychiatry Purchasing Group N/A Defense Cost Inside Limits Definition of a Claim Refer to the attached policy form. Incident or Claim Reporting Provision Refer to the attached policy form. Extended Reporting Period Refer to the attached policy form. Coverage: Description Limit Per Claim Policy/Annual Aggregate Medical Malpractice $1,000,000 $3,000,000 Additional Coverages:_ HIPAA Related Expense Reimbursement ($0 Ded) $25K Data Breach Expense Reimbursement ($0 Ded) $25K Deductibles: Type Coverage Amount Deductible Medical Malpractice $7,500.00 – Per Claim Binding Requirements: Binding Requirements Arthur J. Gallagher Risk Management Services, Inc. must be in receipt of one of the following: a) Payment in full in the form of a check or wire transfer; OR b) An executed Premium Finance Agreement and check or wire transfer for the down payment. c) An accepted carrier payment plan. All required affidavits if applicable. This offer is conditioned upon no material change in the risk occurring between the date of this Proposal and the inception date of the proposed policy. In the event of such change in risk, the carrier may in its sole discretion, whether or not this offer has already been accepted by the Insured, modify and/or withdraw this offer. Coverage is not effective until bound in writing by the carrier. Contingencies: This Quote is subject to our receipt and acceptance of the following items: 1) 5 years currently valued carrier loss runs 2) Five years of currently valued loss runs prior to binding