|
Francine R. ni9lolly signed b9 Frzncine R.
<br />Viiii
<br />Villareal
<br />aCli CERTIFICATE OF LIABILITY INSURANCE
<br />-'�
<br />DATE(MWDDMW)
<br />10/29/2020
<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(ies) 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 endorsement(s).
<br />PRODUCER
<br />CONTACT
<br />NAME: Susan Crain
<br />VIC, Li dbai Vestavia Group
<br />2090 Columbiana Road, Suite 2300
<br />PNON E 205-552-0244 FAx
<br />__.......- (Alc Net: 205-244-8072
<br />—I —__
<br />EMAIL
<br />ADDRESS:
<br />INSURER(S)AFFORDINGCOVERAGE NAICN
<br />Birmingham _, _._ -. AL 35216
<br />INSURER A: Ironshore Insurance Company"A" XV 23647
<br />INSURED
<br />INSURER B: Great American Insurance Company i XV 16691
<br />NaphCare, Inc.
<br />INSURER c: The Travelers Insurance Company"i XV 25658
<br />2090 Columbiana Road, Suite 4000
<br />INSURER D: _
<br />INSURER E:
<br />Birmingham AL 35216 1
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br />THIS Ri TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED 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 />INSURANCE ADOL SUBR: _-..._.
<br />LTR TYPE OF INSURANCE POLICYEFF POLICY EXP-_-
<br />POLICYNUMBER MMlp0/YYYY MMA)0 LIMITS
<br />X COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />Is 1,000,000
<br />'X CLAIMS -MADE OCCUR
<br />-_.
<br />DAMAGE TO RENTED
<br />A —.—�
<br />Y
<br />N
<br />003$$6501
<br />12/31/2019
<br />12/31/2020
<br />PREMISES Eao 'amce)--
<br />$ 50,000
<br />MEe EXP An
<br />( y one perecn)
<br />$ 5,000
<br />_
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />�
<br />GEN'L AGGREGATE
<br />E LIMIT APPLIES PER
<br />GENERAL AGGREGATE
<br />$ 6,500,000
<br />POLICY0 JECT `� LOC
<br />PRODUCTS-COMP/OPAGG
<br />—_
<br />$ 1,000,000
<br />$
<br />OTHER:
<br />AUTOMOBILELIABRUTY
<br />COMBINED SINGLE LIMIT
<br />a ,aoaldenl
<br />s 1,000,000
<br />B ANY AUTO
<br />X _
<br />Y
<br />N
<br />CAP1116396
<br />09/30/2020
<br />09/30/2021
<br />BODILYINJURY {Per person)
<br />$ XXXXXXXX
<br />GwNEO IscHEouLEO
<br />_.. _._
<br />AUTOS ONLY `I AUTOS
<br />BODILY INJURv {per accitlent)
<br />$ XXXXXXXX
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />V--{
<br />(PROPERTY DAMAGE
<br />i (Per acdtlenU
<br />$ XXXXXXXX
<br />A I UMBRELLALIAB L
<br />Y
<br />N
<br />003928601
<br />12131f2019
<br />12/31/2020
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />EXCESSLAB
<br />X1{ coalMs-M40E
<br />AGGREGATE
<br />s 5,000,000
<br />DED RETENTION $
<br />S
<br />WORKERS COMPENSATION
<br />_
<br />X
<br />C AND EMPLOYERS' LIABILnY
<br />Y�
<br />N
<br />UB-1 P248768-20.51-K
<br />09/30/2020
<br />09l3012021
<br />STATUTE .,,_,_! ER
<br />E.L. EACH AcciDENT
<br />_-. -_
<br />$--,,((( ,000
<br />ANYPROPRIETORRARTNER/EXECUTNE
<br />OFFICER)MEMSER EXCLUDED? Y :NIA
<br />UB-1P250924-20-51-R_
<br />.DISEASE -EA EMPLOYEE!$
<br />___-___
<br />1,000,000
<br />NH)
<br />(Mandatory in.rider
<br />If y¢s, describe under i
<br />�,
<br />E.L. DISEASE - POLICY LIMIT
<br />_
<br />$ 1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />A Professional Liability
<br />Y
<br />M
<br />003886501 1
<br />12/31/2019
<br />12/31/2020
<br />Each Med Incident
<br />1,OOQ000
<br />Claims Made
<br />''_
<br />Ann. Aggregate i
<br />6,500,000.
<br />DESCRIPTION OF OPERATIONS LOCATIONS) VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required)
<br />It is understood and agreed the City of Santa Ana, its officers, employees, agents , volunteers, and representatives are named as Additional Insured, as respects
<br />their contract with Naphcare, Inc; the insurance provided by Naphcare, Inc., shall be primary and non-contributory to the insurance carried by the City of Santa
<br />Ana; The City shall receive a (30) thirty day notice of any material modification of the policies, as respects their contract with Naphcare, Inc.
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza (M-30)
<br />P. 0. Box 1988
<br />Santa Ana, CA 92702-1988
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />©1988-2015 ACORD CO
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />Rime MaRaganent Diuiaian
<br />REVIEWED & APPROVED BY:
<br />'� Risk Management Analyst
<br />
|