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712/16/2024
<br /> E(MM/DD/YYYY)
<br /> ACOR" CERTIFICATE OF LIABILITY INSURANCE
<br /> ��
<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 CONTACT
<br /> NAME: Concentra Unit
<br /> Graham Company, PHONE FAX
<br /> a Marsh &McLennan Agency, LLC company vC No Ext: 215-567-6300 vc,No:215-405-2694
<br /> E-MOne Penn Square West ADDRESS: Concentra_Unit@grahamco.com
<br /> Philadelphia PA 19102 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURERA: Columbia Casualty Company 31127
<br /> INSURED CONCGRO-01 INSURER B: Liberty Mutual Fire Ins.Co. 23035
<br /> Occupational Health Centers of California,
<br /> A Medical Corporation INsuRERc:Allied World Assurance Company,AG
<br /> dba Concentra Medical Centers INSURERD: Employers Insurance of Wausau 21458
<br /> 5080 Spectrum Drive, Suite 1200 West INSURERE: LM Insurance Corporation 33600
<br /> Addison TX 75001
<br /> INSURER F
<br /> COVERAGES CERTIFICATE NUMBER:1935939188 REVISION NUMBER:
<br /> THIS IS 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 /> INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD POLICY NUMBER MM/DD MM/DD
<br /> A X COMMERCIAL GENERAL LIABILITY Y Y HAZ4032244581-8 1/1/2024 1/1/2025 EACH OCCURRENCE $1,000,000
<br /> CLAIMS-MADE � OCCUR PREMISES DAMAGE TO
<br /> PREMISES Ea occurrence)
<br /> ccurrence $500,000
<br /> X Professional Lia MED EXP(Any one person) $
<br /> X $1M Claim/$3M Ag PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000
<br /> PRO
<br /> POLICY JECT ❑ LOC PRODUCTS-COMP/OP AGG $3,000,000
<br /> X
<br /> OTHER: $
<br /> B AUTOMOBILE LIABILITY Y Y AS2-631-510199-324 4/1/2024 4/1/2025 COMBINED SINGLE LIMIT $2,000,000
<br /> Ea accident
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> HIRED NON-OWNED FIR ER DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> L $
<br /> A X UMBRELLALIAB X OCCUR Y Y HMC4032235752 1/1/2024 1/1/2025 EACH OCCURRENCE $9,000,000
<br /> EXCESS LAB CLAIMS-MADE AGGREGATE $10,000,000
<br /> DED X RETENTION$ $
<br /> B WORKERS COMPENSATION Y WA7-63D-510199-354 4/1/2024 4/1/2025 X PER OTH-
<br /> E AND EMPLOYERS'LIABILITY Y/N WA5-63D-510199-314 4/1/2024 4/1/2025 STATUTE ER
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000
<br /> OFFICE R/M EMBER EXCLUDED? ❑ N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> D Property YAC-L9L-477341-014 1/1/2024 1/1/2025 SEE BELOW
<br /> C Excess Liability CO23701-009 1/1/2024 1/1/2025 $10M Each Occurrence $10M Aggregate
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> PRIMARY LIABILTY POLICY includes General Liability Coverage on an Occurrence Basis and Professional Liability Coverage on a Claims Made Basis.
<br /> UMBRELLA LIABILITY COVERAGE includes Excess General Liability on an Occurrence Basis and Excess Professional Liability on a Claims Made Basis.
<br /> Both Coverages are excess of a$3,000,000 Self-Insured Retention each Occurrence/Claim subject to a$18,000,000 Aggregate.
<br /> INDIANA PHYSICIAN PROFESSIONAL LIABILITY COVERAGE-Continental Casualty Company-Policy#HAZ 4032244595-10; Effective 1/1/2024-1/1/2025-
<br /> $500,000 Each Medical Incident/$1,500,000 Aggregate Per Insured or Surgeon p
<br /> See Attached... APPROVED
<br /> CERTIFICATE HOLDER CANCELLATION By Cynthia Mora at 1:34 pm, Dec 16, 2024
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> CITY OF SANTA ANA ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Risk Management Division
<br /> 20 CIVIC CENTER PLAZA AUTHORIZED REPRESENTATIVE
<br /> SANTA ANA CA 92702 M
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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