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CERTIFICATE OF LIABILITY INSURANCE °MAY21,292o . ) <br />PRODUCER A 131 SUEDASAMATTE-1 -FIJRMATIQN ONLY AND <br />HUB International insurance Services, Inc. CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS <br />CERTIFICATE DOES NOT AMEND, EXTENO OR ALTER THE COVERAGE <br />600 Corporate Pointe, STE. BOO AFFORDED BY THE POLICIES BELOW. <br />CulverCity, CA 90230 (310 <br />Phone (310)568•5900/ FaX (886)248.6053 <br />AM BEET <br />ALTAMED HEALTH SERVICES CORPORATION <br />2040 CAMFIELD AVE <br />LOS ANGELES, CA 90040 <br />tllu <br />LTR <br />TYPE OF MSUMNC! <br />POLICY NUTAER <br />POLICYEFFECTNE <br />DATE(MMNDNYYY) <br />POLKYEXPIRATION <br />OATE(MMIDONYYY) <br />LIMITS <br />',Yl11lRACCYLSl1TY'. <br />FICN OCCMR9NC6 <br />$2,999,G99' <br />A <br />ewNewdALaeNEAAL uuAm <br />✓ <br />eeuR.LLAaaREwre <br />$4,000,000 <br />OLCU CAm9 MADE <br />WDnP(A". <br />$5,000 <br />Li <br />FEIIFONK aAov llwer <br />$2,000,000 <br />NCL494" <br />0710112019 <br />07/0112020 <br />opNAae TDREmE) <br />Mucous tE.... <br />$100,000 <br />eeMt AocwmArELRRr uEI<a rerc <br />0 E ❑ FRarzaT ❑ Lae <br />FRa -..Mp oa <br />$4,000,000 <br />MEDICAL PROFlSSIONAL LMeARY <br />❑ OCCUR ❑CLAIMS MADE <br />EACH CLAIM <br />AGGREGATE <br />$ <br />$ <br />RETROACTIVE DATE: <br />1w EXCESS LIABItf(Y <br />❑OCCUR ❑CLARIs MADE <br />EACH CLAIM <br />$ <br />AGGREGATE <br />$ <br />' <br />WOMMI1f'Ca„I'EN>ATg11 <br />p <br />LImW « <br />EacA kElNnt <br />3 <br />El. -EA Empbyas <br />S <br />El-PdICY LimN <br />S <br />DESCRI MNOEOPERAMNSILOCAnONS/EXCLUSIONSADDEO sy ENDORSENENTI SPECIAL PROWSIONS <br />RE: Community Development Block Grant Agreement • Coronavirus (CDBG-CV) Funds. City of Santa Ana, <br />We officers, agents, employees, and volunteers are named as additional insured with respect to legal liability <br />arising out of the healthcare services provided by the insured under contract with the certificate holder. <br />Cobeiags is primary & non-contributory. 30 days notice of cancelliation applies. <br />CERTIFICATE HOLDER <br />rewn, a <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED <br />BEFORE THE EXPIRATION DATE THEREOF, THE INSURER AFFORDING <br />CITY OF SANTA ANA ✓ <br />COVERAGE WILL ENDEAVOR TO MAIL 30 DAYS NOTICE TO THE <br />CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO BO <br />ATTN: RISK MANAGEMENT DIVISION - <br />SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE <br />20 CIVIC CENTER PLAZA M31; P.O Box 1988 <br />WSURE ITS AGENTS OR REPRESENTATIVES. <br />AUTHORIZED REPRESENTATIVE <br />SANTA ANA, CA 92702 <br />REVIEWED & APPRO <br />T ' <br />-'� <br />By Risk MANAgeMI NT Div <br />sin <br />Bowman• Pudlik <br />LULU <br />L <br />HUB IIReTTati r lMnurarce SeMm ANGiE AcEvEdo <br />