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A?RD? CERTIFICATE OF LIABILITY INSURANCE 04!005/20151201 DATDD/VYYn <br />1 <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 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 rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />M <br />h Ri <br />k & I CONTACT <br />N ME: <br />ars <br />s <br />nsurance Services PHONE <br />4695 MacArthur Court, Suite 700 aC No): <br />(949) 399-5800 E-MAIL <br /> AD RES : <br />License #0437153 PRODUCER <br />Newport Beach <br />CA 92660 <br />, <br />113206-CAS-11-12 INSURERS AFFORDING COVERAGE NAIC # <br />INSURED INSURER A : Columbia Casually Company 31127 <br />Western Medical Center <br />Inte <br />rated Healthcare Holdin <br />s <br />Inc Lexington Insurance Company <br />INSURER B : 19437 <br />g <br />g <br />, <br />. <br />1301 North Tustin Avenue INSURER C : Philadelphia Insurance Company 23850 <br />Santa Ana, CA 92705 <br /> INSURER D <br /> INSURER E : <br /> INSURER F : <br />COVERAGES CERTIFICATE NUMBER: LOS-001128122-08 REVISION NUMBER: 3 <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 ADDL SUBR Y EFF POLICY EXP <br />LTR TYPE OF INSURANCE POLICY NUMBER MMIDD LIMITS <br />A GENERAL LIABILITY HMU 2097477891-4 04/01/2011 04101/2012 EACH OCCURRENCE $ <br /> X DAMAGE TO RENTED <br /> COMMERCIAL GENERAL LIABILITY <br />- PREMISES Ea occurrence $ <br /> X <br /> CLAIMS-MADE I <br />I OCCUR MED EXP An one person) $ <br /> X Healthcare CLAIMS MADE PERSONAL & ADV INJURY $ <br /> Professional Liab 3-8-05 <br /> GENERAL AGGREGATE $ <br /> GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ SEE BELOW <br /> POLICY PRO LOC $ <br />C AUT OMOBILE LIABILITY PHPK702938 04/01/2011 04/01/2012 COMBINED SINGLE LIMIT $ 1,000,000 <br /> X (Ea accident) <br /> ANY AUTO BODILY INJURY (Per person) $ <br /> ALLOWNEDAUTOS BODILY INJURY (Per accident) $ <br /> SCHEDULED AUTOS <br />PROPERTY DAMAGE <br /> <br />$ <br /> X HIRED AUTOS (Per accident) <br /> X NON-OWNED AUTOS $ <br /> $ <br />A X UMBRELLA LIAB X OCCUR HMU 2097477891-4 04/0112011 04101/2012 EACH OCCURRENCE $ 10,000,000 <br /> EXCESS <br />I X excess of $2,000,000/$10,000,000 ' <br /> L <br />AB <br />CLAIMS-MADE <br />SIR P <br />f <br />i <br />l L <br />bili <br />AGGREGATE 10,000,000 <br />$ <br /> DEDUCTIBLE ro <br />ess <br />ona <br />ia <br />ty & GL SIR $ See Left <br /> X RETENTION RETRO DATE.3-8-05 $ <br /> WORKERS COMPENSATION WC STATU- OTH- <br /> AND EMPLOYERS' LIABILITY <br /> Y 1 N <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFIC <br />M <br /> <br />NIA <br /> <br />E. L. EACH ACCIDENT <br /> <br />$ <br /> ER/MEMBER EXCLUDED? <br />(Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ <br /> If yes, describe under <br /> DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ <br />B EXCESS UMBRELLA 6796942 04/01/2011 04/01/2012 Each Occurrence 15,000,000 <br /> RETRO 3-8-05 Aggregate 15,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Addltlonal Remarks Schedule, If more space Is required) <br />THE CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS AND REPRESENTATIVES ARE INCLUDED AS ADDITIONAL INSUREDS WHERE REQUIRED BY WRITTEN CONTRACT. <br />CLERK OF THE CITY COUNCIL <br />CITY OF SANTA ANA <br />20 CIVIC CENTER PLAZA (M-30) <br />PO BOX 1988 <br />SANTA ANA, CA 92702-1988 <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 />of Marsh Risk & Insurance Services <br />John Graef <br />©1988-2009 ACORD CORPORATION. All rights reserved. <br />ACORD 26 (2009/09) The ACORD name and logo are registered marks of ACORD