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CORRMAN-01 SEMORY <br />'`ac CERTIFICATE OF LIABILITY INSURANCE <br />?? DAT <br />D/YVVY( <br /> 8 <br />11/2 <br />8/1 /2013 <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 CONTACT <br />NAME: <br />Physicians Risk Associates Insurance PHONE FAX <br />(800) 910-6535 <br />(949) 305-6166 <br />26691 Plaza Drive Suite 220 ac Me Eat : <br />aC No : <br />Mission Viejo, CA 92691 ADDRESS <br /> INSURER(S) AFFORDING COVERAGE NAIC k <br /> INSURERA:Arch Specialty Insurance Company <br />INSURED INSURER B-Travelers Indemnity Co of CT 25682 <br />Correctional Managed Care Medical Corporation INSURER C: Everest National Ins Co 10120 <br />4211 E. La Palma Ave. INSURER D: <br />Anaheim, CA 92807 <br />INSURER E <br /> INSURER F : <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <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 <br /> <br />LTR <br /> <br />TYPE OFINSURANCE <br />?UIR <br /> <br />POLICYNUMBER <br />POLICY EFF <br />MM/DD/wvY <br />POLICY EXP <br />MM/DDNYYY <br /> <br />MITS <br /> GENERAL LIABILITY <br />? EACH OCCURRENCE $ 1,000,00 <br />A X COMMERCIAL GENERAL LIABILITY FLP0045679-02 *t9 /1/2013 811/2014 <br />PREMISES Ea occunence 100,00 <br />$ <br /> X CLAIMS-MADE D OCCUR / <br />?nQ/nV <br />_ <br />MED EXP (Any one person) <br />$ 5,00 <br /> ?•J?? PERSONAL B ADV INJURY $ 1,000,00 <br /> GENERAL AGGREGATE $ 3,000,00 <br /> GEN'L AGGRECAT APPLIES PER. PRODUCTS - COMP/OP AGG $ 3,000,00 <br /> POL PRO- LOG ABUSE OR MOLEST $ 1,000,00 <br /> AUT OMOBILE LIABILITY COMBINED <br />S INGLE LIMIT <br />1 <br />000 <br />00 <br /> E <br />accident <br />a , <br />, <br />$ <br />B ANY AUTO 6809447H706TCT13 214/2013 214/2014 BODILY INJURY (Per parson) $ <br /> ALL OWNED <br />AUTOS SCHEDULED <br />AUTOS <br />BODILY INJURY (ParaccitlenQ <br />$ <br /> X X NON-OWNED PROPERTY DAMAGE $ <br /> HIRED AUTOS AUTOS (Pere ccideM <br /> <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION X WC STATU- OTH- <br /> ANDEMPLOYERS'LIABILITY TORY LIMITS ER <br />C ANY PROPRIETCR/PARTNER/EXECUTIVE YIN <br />OFFICER/MEMBER EXCL <br />? <br />NIA CA20010955-131 7/112013 7/112014 E. L. EACH ACCIDENT $ 1,000,00 <br /> UDED <br />(Mandatory in NH) E. L. DISEASE - EA EMPLOYEE $ 1,000,00 <br /> If yes, describe under <br /> DESCRIPTION OF OPERATIONS belcw EL.DISEASE -POLICY LIMIT $ 1,000,00 <br />A Professional Liab. FLP0045679-02 81112013 8/1/2014 See Limits Below <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, U more space is required) <br />•30 Days notice of cancellation, 10 days for non-payment of premium. <br />Limits: Professional Liability & Managed Care Errors and Omission $1,000,000 per Event $6,000,000 Policy Aggregate. General Liability Retroactive date: <br />08101/2002. Professional Liability& Managed Care Errors and Omissions Retroactive date: 03101/1998. Included under General Liability: $1,000,000 Each Claim <br />Sub-Limit for Abuse or Molestation 1$1,000,000 Policy Aggregate Sub-Limit for Abuse or Molestation. <br />Certificate Holder is Additional Insured for General & Professional Liability per endorsements (Additional Insured - Designated Person or Organization & <br />Waiver of Transfer of Rights of Recovery Against Others To Us) attached. <br />CERTIFICATE HOLDER t,p pt2OVED CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />- -- <br />Laura A. Rossini THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Assistant City Attorney <br /> AUTHORIZED REPRESENTATIVE <br />City of Santa Ana <br />62 Civic Center Plaza <br />Santa Ana CA 92702 <br />ACORD 25 (2010/05) <br />©1988-2010 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD