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CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
<br /> 09127/2024
<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(lies) 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 e stone
<br /> McGriff Insurance Services,LLC PHONE 404 497-7500 FAX
<br /> Rileyy
<br /> NAME: P
<br /> 3400 Overton Park Drive SE Ale No Ext: A/C No):
<br /> Suite 300 E-MAIL - —�
<br /> Atlanta,GA 30339 ADDRESS:n)Py.shepstone@mcgriff.com
<br /> FA A Ee UAJ 0-
<br /> _ P S A. .-An to surane Comp19437
<br /> INSURED -I �a 1 E a n . 'r a t
<br /> Care Ambulance Services,Inc.
<br /> 1517 West Braden Court INSURcr,a:XL Insurance America,Inc. 24554
<br /> Orange,CA 92868
<br /> INSURER D:
<br /> INSURER E
<br /> INSURERF:
<br /> COVERAGES CERTIFICATE NUMBER:FKEDTWLP 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 I TypE 4F INSURANCE ADDL SUBR POLICY EFF POLICY EXP
<br /> LTR IN D POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY 6796591 10101/2024 10/0112025 EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE ® OCCUR OAMA O RENTED 25,000
<br /> PREMISES Ea occurrence $
<br /> MED EXP(Any one person) $ 5,000
<br /> x x PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> �+ POLICY PRO- LOC PRODUCTS-COMPIOP AGG $ 1,000,000
<br /> JECT
<br /> OTHER: $
<br /> B AUTOMOBILE LIABILITY RAD500047609 10/01/2024 10/01/2025 COMBINED SINGLE LIMIT
<br /> Ea accident $ 5,000,000
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED X X BODILY IN $
<br /> AUTOS ONLY AUTOS JURY(Per accident)
<br /> HIRED NON-OWNED PROPERTY DA MAGE
<br /> AUTOS ONLY AUTOS ONLY Per accident $
<br /> $
<br /> UMBRELLA LIAR OCCUR EACH OCCURRENCE $
<br /> EXCESS LIAR CLAWS-MADE
<br /> AGGREGATE $
<br /> DIED RETENTION$ $
<br /> C WORKERS COMPENSATION RWD300095509 10/01/2024 10101/2025 X PER oTH-
<br /> AND EMPLOYERS'LIABILITY YIN STATUTE I I E
<br /> ANY PROPRIET0PJPARTNERIFX.ECU0
<br /> IVE ❑ E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICERIMEMBEREXCLUDED? NIA NIA X
<br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> It yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1.000,000
<br /> A Professional Liability 6798591 10/01/2024 10101/2025 Per Claim $ 1,o00,000
<br /> Aggregate $ 2.000,000
<br /> $
<br /> $
<br /> $
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required)
<br /> Aggregate Limit per location onty applies where required by written contract.
<br /> Umbrella 1 Excess Follows Form.
<br /> The City of San Ana is included as Additional Insureds as respects to General Liability and Automobile Liability,as required by written contract. Waiver of Subrogation is in
<br /> favor of the Additional Insured for the General Liability,Auto, and Workers'Compensation policies referenced herein as required by written contract.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRI
<br /> THE EXPIRATION DATE THEREOI _ RIskMmAgetttraf:E3t�ktilAs
<br /> ACCORDANCE WITH THE POLICY PRO r RE1nESUEo6tAAPRar€rT13fr
<br /> City Of Santa Ana AUTHORIZED REPRESENTATIVE ' T164Frt+
<br /> 20 Civic Center Plaza,4th floor Risk Management5pecialist
<br /> Santa Ana,CA 92702
<br /> Page 1 of 2 O 1988-2015 ACORD CORPORATION. All rights reserved.
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