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CERTIFICATE OF LIABILITY INSURANCE ATE DNYYY) <br />I <br />page 1 of 1 <br />1 <br />03 <br />01/2012 <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 be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer ri <br />hts to the <br />g <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER CONTACT <br />Willi <br />f N <br />k NAME: <br />s o <br />ew Yor <br />, Inc. PHONE <br />FAx <br /> <br />c/o 26 Century Blvd. 877-945-7378 <br />? <br />888-467-2378 <br />P. 0. Box 305191 <br />Nashville <br />TN 37230-5191 -MAIL Ce rtif'cates@1g".7.8 COm - <br />, INSURERS AFFORDING COVERAGE E NAIC # <br />_ INSURERA:Arch specialty insurance Company 21199-002 <br />INSURED <br />Care Ambulance Service, Inc. INSURERB?Liberty Mutual Fire Insurance Company 23035-001 <br />1517 Braden Court <br />O <br />CA INSURERC.IF Skadeforsakrings AB <br />"-- -"-'-? F9367-001 <br />range, <br />92868 INSURERD:Liberty Insurance Corporation 42404-001 <br />+ INSURER E: <br /> INSURER F: <br /> -_-- --"'- "-"'--•••-• - -?? r\?viJIV1Y IYVIe1pCR. <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 /> , <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> RJSR <br />TYPE OP INSURANCE DD' SUB F{ <br />POLICY NUMBER POUCYEFF POLICY EXP <br />LIMITS <br /> A ? GENERAL LIABILITY !FLP0046376-00 10/1/2011 110/1/2012 EACHOCCURRENCE $ 5 000 000 <br /> 1 X I COMMERCIAL GENERAL LIABILITY <br /> <br />CLAIMS-MADE OCCUR DAMAGE TO RENTED <br />_EREMISES(Eaoaurence <br />$ 300,000 <br /> I MEAD EXP(Any one person) S .5 ,000 <br /> PERSONALBADVINJURY S <br /> 5,000.000 <br /> GENERALAGGREGATE $ <br /> 5 000 000 <br /> GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOPAGG $ 5,000,000 <br /> X POLICY I PRO-71 ,LFCT <br />LOG <br />S <br />B AUT <br />1 OMOBILE LIABILITY <br />` I AS2631510005021 10/1/2011 10/1/2012 OMaccident) 13EINGLELIMIT $ 5,000,000 <br /> X : ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY(Per accident) <br />$ <br /> WNED <br />HIREDAUTOS 1 <br />O <br />O AMAGE <br />Pe <br />cd-? n <br />a <br /> ?AU <br />T <br />S r <br />c <br />t) $ <br /> 1 $ <br />C am. UMBRELLALIAB X ; OCCUR LP0000025622-11 10/1/2011 10/1/2012 ! EACH OCCURRENCE $ 10,000,000 <br />i __71 X EXCESS LIAB CLAIMS-MADE ! AGGREGATE <br />$ 10 <br />000 <br />000 <br /> , <br />, <br /> DED RETENTION $ $ <br />D WORKERS COMPENSATION <br />AND EMPLOYERS'LIABILIY y WA7-63D-510005-011 0/1/2011 10/1/2012i X W A <br />Y111! R <br /> /N <br />ANY PROPRIETORIPARTNERIEXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />N1AI I _ <br />E. L. EACH ACCIDENT f$ 1,000,000 <br />---°-.------ <br /> ((Mandatory,in NH) <br />(fyes <br />descnbeunder E.L. DISEASE • EA EMPLOYEE IS 1,000,000 <br /> , <br />DESCRIPTION OF OPERATIONS below E.L. DISEASE • POLICY LIMIT S 1,000,000 <br /> rofessional Liab FLP0046376-00 1 10/1/2011 10/1/2012 <br />7 Each Medical incident $5,000,000 <br /> 1 Agg regate $5,000,000 <br />DESCRIPTION OF OPERATIONS! LOCATIONS 1 VEHICLES (Attach Acord 101, Additonal Remarks Schedule, if more space is required) <br />Proof of Coverage <br />The City of Santa Ana, its officers, officials, employees, agents and volunteers are included as <br />additional insureds and Primary and Non-contributory wording applies as respects to General <br />Liability. <br /> <br /> <br />City of Santa Ana <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 />Coll:3650830 Tpl:1338995 Cert:1 7666 ©1988-2010ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD