WITTMAN ENTERPRISES, LLC HIPAA BUSINESS ASSOCIATE AGREEMENT -2009

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WITTENT -01 A�°R ©� CERTIFICATE OF LIABILITY INSURANCE DAT6/25/2012rr) 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. 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 CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(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 endorsement(s). PRODUCER CONTACT Tracy Dolan Wells Fargo Insurance Services USA, Inc. PHONE FAX " ac No Ext): 916 231 -1757 A/C No): 231 -1868 CA DOI Lic. #OD08408 (916) 231 -1741 _916 — - - -- E -MAIL trot . ADDRESS: y dolan @wellsfargo.com 11017 Cobblerock Drive, Suite 100 INSURER(S) AFFORDING COVERAGE NA_IC # Rancho Cordova, CA 95670 -6049 _ _ INSURER A: National Fire Insurance $ 300,000 INSURED INSURER B : National Fire Insurance Company of Hartford 20478 Wittman Enterprises, LLC INSURER C: Hartford Casualty Insurance Company 29424 PO Box 269110 -- - " - - -- -- INSURER D: Evanston Insurance Company 35378 INSURER E - -- $ 2,000,000 Sacramento, CA 95826 INSURER F: COVERAGES CERTIFICATE NUMBER: 4514657 REVISION NUMRER- coo h.1— 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 ADDL SUBR -- - POLICY NUMBER POLICY EFF MM /DDIYYYY POLICY EXP MMIDDIYYYY - -- - — LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY 4034654035 07/01/2012 07/01/2013 EACH OCCURRENCE 2,000,000 _______$ "AGE-TO RENTED PREMISES jEa occurrence) $ 300,000 _ MED EXP (Any one person) $ 10,000 i CLAIMS -MADE i X 1OCCUR PERSONAL & ADV INJURY - -- $ 2,000,000 __ _ GENERAL AGGREGATE $ 4,000,000 PRODUCTS - COMP /OP AGG $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY E OT- -� LOC " "_- —_..- $ - -_. _ - B AUTOMOBILE LIABILITY ANY AUTO 84012487490 07/01/2012 07/01/2013 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) _ $ Ix ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY ( Per accident ) $ HIRED AUTOS X NON -OWNED AUTOS $ _ PROPERTY DAMAGE Peraccident) $ C X UMBRELLA LIAB X OCCUR 4034654083 07/01/2012 07/01/2013 i EACH OCCURRENCE -- 2,000,000 - EXCESS LIAB � CLAIMS -MADE AGGREGATE $ 2,000,000 DE17 X RETENTION $ 10,000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER ? EMBER EXCLUDE ❑ NIA , WC STATU- OTH- LTW11 LIMITS ER " E.L. EACH ACCIDENT - $ - E.L. DISEASE - EA EMPLOYEE — $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below — E.L. DISEASE -POLICY LIMIT - -- - - - - - -- $ D Prof Liability E0850756 07/01/2012 07/01/2013 $1,000,000/$2,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Certificate holder named additional insured per attached form. *10 day notice applies if cancelled for non - payment of premium. % La 1 i Slit City of Santa Ana 1439 Broadway Santa Ana, CA 92701 V VG 11Vnx SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE i ne AL urcu name and logo are registered marks of ACORD © 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105)