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ACORO® CERTIFICATE OF LIABILITY INSURANCE <br />16#./ <br />DATE(MNVDD/YYYY) <br />1 10/24/2019 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not Confer rights to the certificate holder In lieu of such endorsements . <br />PRODUCER <br />CONTACT - <br />NAME: Susan Crain <br />VIG, LLC., dba7The Vestavia Group <br />PxawE , 205-552-0241 205-244-6072 <br />2090 Columbiana Road. Suite 2300 <br />EMAIL <br />ADDRESS: <br />INSURER(S)AFFORDING COVERAGE <br />NAIC0 <br />INSURERA: lronShoreSpecieftyinsuranoe A XV <br />14375 <br />Binnin ham AL 35216 <br />INSURED <br />INSURER B: Great American Insurance A+XIV <br />16691 <br />INSURER C : The Travelers Insurance Company A++XV <br />19046 <br />NaphCare, Inc. <br />INSURER D <br />2090 Columbiana Road, Suite 40DO <br />INSURER E : <br />INSURER F: <br />Birmingham AL 35216 <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />TYPE OF INSURANCEJim <br />ADOLSUBIR <br />J= <br />POUCYNUMBER <br />POLICY EFF <br />SV <br />POLICY EXP <br />M <br />LIMITS <br />COMMERCIALGENERALLIAaIUTY <br />EACH OCCURRENCE <br />$ 1,000,000 <br />A <br />X CLAIMS -MADE OCCUR <br />Y <br />N <br />003886500 <br />12/312018 <br />1251/2019 <br />DAMAGE TOR <br />PR MIS S Ee P. <br />$ 50,000 <br />MED EXP (Any one parson) <br />3 5,000 <br />PERSONAL& ADVINJURY <br />$ 1,000,000 <br />GENE AGGREGATE LIMIT APPLIES PER: <br />GENERALAGGREGATE <br />$ 5,000,000 <br />POLICY ❑ jE�T LOC <br />PRODUCTS - COMPIOP AGG <br />S 1,000,000 <br />$ <br />OTHER <br />AUTOMOBILE <br />LIABILITY <br />COMOIN90 SINGLE LIMIT <br />Ea accident <br />S 1,000,000 <br />B <br />X <br />ANY AUTO <br />Y <br />N <br />CAP1116382 <br />09/30/201g <br />091302020 <br />BODILY INJURY (Per parson) <br />S XXXXXXX <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY (Per accident) <br />S XXXXXXX <br />HIRED NON-0WNEO <br />AUTOS ONLY AUTOS ONLY <br />PROPERTY DAMAGE <br />Perecddenl <br />$ XXXX)= <br />S <br />UMBRELLA OAS <br />OCCUR <br />Not Applicable <br />XXXXXXXX <br />XXXXXXXX <br />EACH OCCURRENCE <br />S %OOLIOCf <br />AGGREGATE <br />S XXXKKXX <br />EXCESS LIAR <br />CLAMS -MADE <br />DED RETENTION S <br />S <br />C <br />WORKERS COMPENSATION <br />AND EMPLOYERS'LIABILITY YIN <br />ANYPROPRIETORIPARTNERIE%ECUTIVE <br />OFFICERIMEMBEREXCLUDED9 a <br />(Mandatory In NH) <br />NIA <br />N <br />UB-1P248768-19-51-K <br />UB-1P250924-19-51-R <br />09/302019 <br />09l3012020 <br />PER O H- <br />x srnr r ER <br />E.L. EACH ACCIDENT <br />S 1.000.000 <br />E.L. DISEASE - EA EMPLOYEE <br />s 1,000.000 <br />R yes. describe under <br />DESCRIPTION OF OPERATIONS bob <br />E.L DISEASE - POLICY LIMIT <br />S I,000,000 <br />A <br />Professional Liability <br />Y <br />N <br />0388610/1 <br />12/312/118 <br />12/31/2019 <br />Each Med. Incident <br />1,000,000 <br />Claims Made <br />Ann. Aggregate <br />5,000,000 <br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101. Additional Remarks Schedule,may lea attached if more apace Is requlrad) <br />It is understood and agreed the City of Santa Ana, officers, employees, agents, volunteers and representatives are named as additional insured as respects their <br />Contract with NaphCare, Inc.; the insurance carded by NaphCare, Inc., shall be primary and non-contributory to insurance carried by the City of Santa Ana; if <br />policies are changed or materially modified a thirty (30) day Written notice will be provided to the City of Santa Ana as respects their Contract with NaphCare, Inc. <br />REVIEWED & APPROVED <br />By RISk MANAGEMENT DIVISION <br />CERTIFICATE HOLDER nnr n .. GANGELLATION <br />City of Santa Ana <br />S NY ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Risk Management Division <br />9 FRANCINE R. <br />N DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />V W TH THE POLICY PROVISIONS. <br />20 Civic Center Plaza, 4th Floor <br />AUTHORIZED REPRESENTATIVE <br />Santa Ana, CA 92702 <br />urL C'A.a,-k) <br />01988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />