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AC"RUF CERTIFICATE OF LIABILITY INSURANCE <br /> <br />/YYYY) <br />DATE5/2011 <br />zo1 <br />04/05/2011 <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 CONCT <br />NAME:TA <br />Marsh Risk & Insurance Services FAX <br />PHONE <br />4695 MacArthur Court, Suite 700 (AC. Nol: <br />(949) 399-5800 IIAAIL <br /> A RESS: <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 Casualty Company 31127 <br />Western Medical Center <br />t <br />d H <br />lth <br />ldi <br />I <br />H <br />I Lexington Insurance Company <br />INSURER B : 19437 <br />egrate <br />ea <br />care <br />o <br />ngs, <br />nc. <br />n <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 CY EFF POLICY EXP <br /> <br />L TYPE OF INSURANCE POLICY NUMBER MM/D LIMITS <br />A GENERAL LIABILITY HMU 2097477891-4 04/01/2011 04/01/2012 EACH OCCURRENCE $ <br /> X RETED <br />A <br />E <br />O <br />oc <br /> COMMERCIAL GENERAL LIABILITY P <br />EM S <br />S <br />a <br />currence $ <br /> CLAIMS-MADE FTIOCCUR MED EXP (Anyone person) $ <br /> X Healthcare CLAIMS MADE PERSONAL & ADV INJURY $ <br /> Professional Liab 3-8-05 GENERAL AGGREGATE $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ SEE BELOW <br /> POLICY PRO LOC $ <br />C AUT OMOBILE LIABILITY PHPK702938 0410112011 04/01/2012 COMBINED SINGLE LIMIT $ 1,000,000 <br /> <br />X (Ea accident) <br /> ANY AUTO -'- <br /> BODILY INJURY (Per person) $ <br /> ALL OWNED AUTOS <br />BODILY INJURY (Per accident) <br />$ <br /> SCHEDULED AUTOS <br />PROPERTY DAMAGE <br /> X <br />HIRED AUTOS <br />(Per accident) $ <br /> X NON-OWNED AUTOS $ <br /> $ <br />A X UMBRELLA LIAB X OCCUR HMU 2097477891-4 04/0112011 0410112012 EACH OCCURRENCE $ 10,000,000 <br /> Excess LIAB X excess of $2,000,0001$10,000,000 10 <br />000 <br />000 <br /> CLAIMS-MADE SIR P <br />f <br />i <br />l Li <br />bilit <br />& GL AGGREGATE , <br />, <br />$ <br /> DEDUCTIBLE ro <br />ess <br />ona <br />a <br />y SIR $ See Left <br /> X RETENTION RETRO DATE 3-8-05 $ <br /> WORKERS COMPENSATION W C STATU- OTH- <br /> <br />AND EMPLOYERS' LIABILITY FEL_ <br /> Y I N <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE NIA <br />E.L. EACH ACCIDENT <br />$ <br /> OFFICER/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, Additional 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 />,-r-m I IriL A I e <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