Extract insurance certificate information from the following document.
insured_name must be the PERSON name of the physician/medic (beneficiary), NOT the institution or practice name.
Markdown content:
**==> picture [364 x 43] intentionally omitted <==**
**----- Start of picture text -----**<br>
Gy OMIC 7<br>= i OPHTHALMIC MUTUAL :<br>Ven INSURANCE COMPANY<br>S A Risk Retention Group<br>**----- End of picture text -----**<br>
# CERTIFICATE OF PROFESSIONAL LIABILITY INSURANCE
Certificate Issued to:
Sani Surgery Center 1315 Tablas Rd Templeton, CA 93465
Name and Address of Insured:
**==> picture [143 x 35] intentionally omitted <==**
**----- Start of picture text -----**<br>
Sharon McCaffery Theodore, MD<br>5660 Tamarisk Way<br>San Luis Obispo, CA 93401<br>**----- End of picture text -----**<br>
**==> picture [203 x 71] intentionally omitted <==**
**----- Start of picture text -----**<br>
Policy Number: OMC0015290<br>Retroactive Date: 05/20/2019<br>Insured Since: 03/01/2022<br>Policy Period: 03/01/2025 to 03/01/2026<br>Class: Surgery Class 3<br>Insured Type: Ophthalmologist<br>**----- End of picture text -----**<br>
**==> picture [322 x 58] intentionally omitted <==**
**----- Start of picture text -----**<br>
Primary Limits of Liability: [x] Separate CL) Shared<br>$1,000,000 each Claim<br>$3,000,000 aggregate<br>**----- End of picture text -----**<br>
## Coverage is issued on a claims-made and reported basis.
This Certificate of Insurance is issued as a matter of information only and confers no rights upon the holder. By its issuance, OMIC does not modify or extend the provisions of its policy and does not waive any of its rights thereunder. In the event this coverage is terminated, OMIC will attempt to give written notice to the party listed above to whom this Certificate is issued, but failure to give notice will impose no obligation upon OMIC. Notice of termination will be given to the Insured as provided in the policy.
## Certificate Issued by:
**==> picture [408 x 72] intentionally omitted <==**
**----- Start of picture text -----**<br>
Ophthalmic Mutual Insurance Company Date: 01/16/2025<br>655 Beach Street<br>San Francisco CA 94109-1336 |Renna<br>Authorized Representative<br>**----- End of picture text -----**<br>
Certificate Holder Copy
Pre-extracted NER entities:
- COVERAGE_AMOUNT: $1,000,000, $3,000,000
- COVERAGE_TYPE: PROFESSIONAL LIABILITY
- EFFECTIVE_DATE: 05/20/2019, 03/01/2022, 03/01/2025, 03/01/2026, 01/16/2025
- POLICY_NUMBER: OMC0015290, Policy N, Policy P
Return ONLY a valid JSON object with: insured_name, insurance_company, policy_number, coverages (array of {coverage_type, limit_per_occurrence, limit_per_occurrence_units, aggregate_limit, aggregate_limit_units}), effective_date, expiration_date, is_signed (boolean). For limits: extract BOTH - limit_per_occurrence (per claim) AND aggregate_limit (look for "Aggregate", "Each Calendar Year Aggregate" - amount often in same table row). Units: ONLY short words (million, thousand, dollars, M, K) or null - no explanations. Use EXACT numbers. No scientific notation. No other text or markdown.