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AGENCY CUSTOMER ID: CONCGRO-01 <br /> LOC#: <br /> ,a`oRo ADDITIONAL REMARKS SCHEDULE Page 1 of 1 <br /> AGENCY NAMED INSURED <br /> Graham Company, Occupational Health Centers of California, <br /> A Medical Corporation <br /> POLICY NUMBER dba Concentra Medical Centers <br /> 5080 Spectrum Drive, Suite 1200 West <br /> Addison TX 75001 <br /> CARRIER NAIC CODE <br /> EFFECTIVE DATE: <br /> ADDITIONAL REMARKS <br /> THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br /> FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE <br /> KANSAS PHYSICIAN PROFESSIONAL LIABILITY COVERAGE-Continental Casualty Company-Policy#HAZ 4032244600-12; Effective 1/1/2026-1/1/2027- <br /> $500,000 Each Medical Incident/$1,500,000 Aggregate Per Insured or Surgeon <br /> LOUISIANA PHYSICIAN PROFESSIONAL LIABILITY COVERAGE-Columbia Casualty Company-Policy#HAZ 4032244614-12; Effective 1/1/2026-1/1/2027- <br /> $100,000 Each Medical Incident/$300,000 Aggregate Per Insured or Surgeon <br /> NEBRASKA PHYSICIAN PROFESSIONAL LIABILITY COVERAGE-Continental Casualty Company-Policy#HAZ 4032244628-12; Effective 1/1/2026-1/1/2027 <br /> -$800,000 Each Medical Incident/$3,000,000 Aggregate Per Insured or Surgeon <br /> PENNSYLVANIA PHYSICIAN PROFESSIONAL LIABILITY COVERAGE-Columbia Casualty Company-Policy#HAZ 4032244631-12; 1/1/2026-1/1/2027- <br /> $500,000 Each Medical Incident/$1,500,000 Aggregate Per Insured or Surgeon <br /> WISCONSIN PHYSICIAN PROFESSIONAL LIABILITY COVERAGE-Continental Casualty Company-Policy#HAZ 4032244659-12; 1/1/2026-1/1/2027- <br /> $1,000,000 Each Medical Incident/$3,000,000 Aggregate Per Insured or Surgeon <br /> PROPERTY COVERAGE:$5,000,000 Limit for Unnamed/Unscheduled Locations; Specified Limits for Scheduled Locations. <br /> SEPARATE WORKERS'COMPENSATION POLICIES FOR INSURED ENTITIES AS FOLLOWS: <br /> WORKERS COMPENSATION-Concentra Health Services, Inc.-Pennsylvania Manufacturers Association Insurance Company-Policy#202675-1689413A(All <br /> Other States) ; Effective:4/1/2026-4/1/2027 <br /> WORKERS COMPENSATION-Concentra Health Services, Inc.-Pennsylvania Manufacturers Association Insurance Company-Policy#202600-1689413B <br /> (WI); Effective:4/1/2026-4/1/2027 <br /> WORKERS COMPENSATION-Occupational Health Centers of California,A Medical Corporation-Pennsylvania Manufacturers Association Insurance Company <br /> -Policy#202675-1689421; Effective:4/1/2026-4/1/2027 <br /> WORKERS COMPENSATION-Occupational Health Centers of Southwest, P.A.-Pennsylvania Manufacturers Association Insurance Company-Policy <br /> #202675-1689439A(All Other States); Effective:4/1/2026-4/1/2027 <br /> WORKERS COMPENSATION-Occupational Health Centers of Southwest, P.A.-Pennsylvania Manufacturers Association Insurance Company-Policy <br /> #202600-1689439B(WI); Effective:4/1/2026-4/1/2027 <br /> ADDITIONAL WORKERS COMPENSATION POLICIES: <br /> OHC of Alaska—Pennsylvania Manufacturers Association Insurance Company-Policy#202600-1689686; Effective:4/1/2026-4/1/2027 <br /> OHC of Arkansas—Pennsylvania Manufacturers Association Insurance Company-Policy#202600-1689694; Effective:4/1/2026-4/1/2027 <br /> OHC of Southwest(AZ/UT)—Pennsylvania Manufacturers Association Insurance Company-Policy#202600-1689660; Effective:4/1/2026-4/1/2027 <br /> OHC of Delaware—Pennsylvania Manufacturers Association Insurance Company-Policy#202600-1689702; Effective:4/1/2026-4/1/2027 <br /> OHC of Georgia/Hawaii—Pennsylvania Manufacturers Association Insurance Company-Policy#202600-1689629; Effective:4/1/2026-4/1/2027 <br /> OHC of Illinois—Pennsylvania Manufacturers Association Insurance Company-Policy#202600-1689637; Effective:4/1/2026-4/1/2027 <br /> OHC of Louisiana—Pennsylvania Manufacturers Association Insurance Company-Policy#202600-1689744; Effective:4/1/2026-4/1/2027 <br /> OHC of Michigan—Pennsylvania Manufacturers Association Insurance Company-Policy#202600-1689751; Effective:4/1/2026-4/1/2027 <br /> OHC of Nebraska—Pennsylvania Manufacturers Association Insurance Company-Policy#202600-1689777; Effective:4/1/2026-4/1/2027 <br /> OHC of New Jersey—Pennsylvania Manufacturers Association Insurance Company-Policy#202600-1689710; Effective:4/1/2026-4/1/2027 <br /> OHC of North Carolina—Pennsylvania Manufacturers Association Insurance Company-Policy#202600-1689652; Effective:4/1/2026-4/1/2027 <br /> OHC of Southwest(KS)—Pennsylvania Manufacturers Association Insurance Company-Policy#202600-1689645; Effective:4/1/2026-4/1/2027 <br /> Therapy Centers of Southwest I, PA(OR)-Pennsylvania Manufacturers Association Insurance Company-Policy#202600-1689678; Effective: <br /> 4/1/2026-4/1/2027 <br /> Therapy Centers of South Carolina, PA-Pennsylvania Manufacturers Association Insurance Company-Policy#202600-1689736; Effective:4/1/2026-4/1/2027 <br /> OHC of Minnesota-Pennsylvania Manufacturers Association Insurance Company-Policy#202600-1689769; Effective:4/1/2026-4/1/2027 <br /> OHC of West Virginia-Pennsylvania Manufacturers Association Insurance Company-Policy#202600-1689728; Effective:4/1/2026-4/1/2027 <br /> CYBER LIABILITY- Arch Specialty Insurance Company-Policy#NPL2001106-01; Effective: 11/25/2025-01/01/2027-Limit:$10,000,000 <br /> CRIME COVERAGE—National Union Fire Insurance Company of Pittsburgh, PA—Policy#04-173-83-24, Effective 01/01/2026—01/01/2027—Limit <br /> $10,000,000 <br /> Coverage is provided for all medical professionals currently or previously employed or contracted by the above Named Insured,but only for professional services <br /> performed for or on behalf of the above Named Insured. <br /> RE: OHC OF CA/CMC HAS AN AGREEMENT UNDER#A-2019-006 TO PROVIDE MEDICAL SERVICES TO THE EMPLOYEES OF THE NAMED CLIENT. <br /> CITY OF SANTA ANA, ITS OFFICERS,AGENTS,VOLUNTEERS AND EMPLOYEES are all included as additional insureds on the above General Liability, <br /> Auto Liability and Umbrella Liability Policies and coverage shall apply on a Primary and Non-Contributory basis if required by written contract. <br /> Prior to loss,and if required by written contract,Waiver of Subrogation is provided on General Liability,Auto Liability, Umbrella Liability and Workers <br /> Compensation Policies for work performed under contract if permissible by state law. <br /> ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />