WITTMAN ENTERPRISES, LLC HIPAA BUSINESS ASSOCIATE AGREEMENT -2009

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�`1 Ll� i %,17D"l '-' ��.� / WITTENT -01 AGIMROTH .�coRO� CERTIFICATE OF LIABILITY INSURANCE �� DATE (MM /DD/YYYY) 6/29/20�'I _ _ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED �' REPRESENTATIVE OR PRODUCER, AND THE CE�iTdFI�A�TE ODD _ IMPORTANT: If the certificate holder is an ADDITIONAL INSU RED; tl�e i7ty(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements .` - � - � PRODUCER LICen Se i/ OG9848O ". �� NTACT NAME - Western Elite Insurance Solutions ' � ' ' PO BOX 2980 Rocklin, CA 95677 '-PH°I'IE 9'16 259 -6900 FP'X (866) 206 -8646 A/C No Ezt : ( ) A/C No E -MAIL ADDRESS: INSURER S) AFFORDING COVERAGE NAIC p INSURER A: RQpUbIiC Indemnity Compan INSURED INSURER B - _ INSURER C Wittman Enterprises LLC INSURER D PO BOX 269'1'1 O Sacramento, CA 95826 INSURER E INSURER F COVERAGES CERTIFICATE NUP- .^.BER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE POLICY NUMBER MM DD/YYYY MM /DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ PREMISES Ea occurrence $ COMMERCU\L GENERAL LIABILITY CLAIMS�NADE � OCCUR MED EXP (Any one person) S PERSONAL B. ADV INJURY $ GENERAL AGGREGATE $ w� APPR AS M GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ POLICY PRO LOC $ AUTOMOBILE LIABILITY J COMBINED SINGLE LIMIT Ea accitlant BODILY INJVRY (Par parson) $ ANY AUTO / AUTOS NED AUTOSULED AITB A M. C �� BODILY INJURY (Per accitlen[) $ FeOscud DAMAGE $ HIRED AUTOS AN�NO NRJED Te....t�. City Attorse a�^�ii�^�'' $ UMBRELLA DAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS DAB CLAIMS�AADE DED RETENTION $ $ A AND EMPLOYERSE DABIDTY ANY PROPRIETOR/PARTNER/EXECUTIVE Y(� 'L 8'1894 -Oi 7 /'I /2U'I� 7 /'I /2U'I2 X V�/C STATU- OTH- E. L. EACH ACCIDENT $ �I,000sOOO OFFICER/MEMBER EXCLUDED4 I J (Mantlatcry in NH) N/A - E.L. DISEASE - EA EMPLOYEE $ f ,000,000 I( yes, describe untler DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 tv �� O _� DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Atltlklonal Rsmarb Schedule, H more specs Ie requlrad) L_ TI Q C r— � � I m c/-, c.J'I o b rT, z �_ D W Y z CERTIFICATE HOLDER CANCELLATION W SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. '1439 S. Braodway Santa Ana, CA 92707 AUTHORIZED REPRESENTATIVE I ©'1988 -20'10 ACORD CORPORATION. All rights reserved. ACORD 25 (20'10/05) The ACORD name and logo are registered marks of ACORD