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<br />CORRMAN-01 SEMORY
<br />I& CERTIFICATE OF LIABILITY INSURANCE °A,
<br />
<br />,
<br />81/2012 20/2
<br />0113 3
<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(les) 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 />
<br />
<br />Associates Insurance
<br />Phy
<br />siclans
<br />Risk
<br />
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<br />
<br />.800) 910.6535 ac NO : (949) 305-6166
<br />UVC PHO, N
<br />91
<br />Plaza
<br />Drive Suite 220
<br />266
<br />Mission Viejo, CA 92891 ADDRESS:
<br />
<br /> INSURER(S) AFFORDING COVERAGE NAICe
<br /> INSURERA:Arch Specialty Insurance Company
<br />INSURED INSURERS: Travelers Indemnity Co of CT 25682
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<br />ti INSURER C: Everest National Ins Co 10120
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<br />4211 E. La Palma Ave. INSURER D :
<br />Anaheim, CA 92807 INSURER E
<br /> INSUYtER F
<br />Cf)VFRAGES CERTIFICATF NtIMRER- 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 CONTRACTOR 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 />I TYPE OF INSURANCE POLICY NUMBER M POLICY EFF MM POLICY P WAR WVn LT
<br />R LIMITS
<br />GENERAL LIABILITY EACH OCCURRENCE $ 2,000,00
<br />A X COMMERCIAL GENERAL LIABILITY FLP0045679-02 81112013 811/2014 PREMISES Ea occurrence $ 100,00
<br />X CLAIMS-MADE 71OCCUR NED EXP(An, One pereon) $ 6,00
<br /> PERSONAL&ADV INJURY $ 2,000,00
<br /> GENERAL AGGREGATE $ 3,000,00
<br />GEN'L AGGREGATELIMIT APPLIES PER: PRODUCTS -COMP/OPAGG $ 3,000,00
<br />PRO- BUSE OR MOLEST $ 1
<br />000
<br />00
<br />_CT I
<br />Loc
<br />POLICY ,
<br />,
<br /> AUTOMOBILE LIABILITY EOBMBB?INdEeDISINGLE LIMIT $ 1,000,00
<br />B ANY AUTO 6809447H706TCT13 21412013 2/4/2014 BODILY INJURY (Par pawn) $
<br /> ALL OWNED
<br />AUTOS SCHEDULED
<br />AUTOS BODILY INJURY (Per accldeM) $
<br />
<br />I NON-OWNED - PR PERTV DAMA E $
<br /> x HIREDAUTOS X AUTOS Paracld.m
<br /> $
<br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $
<br />
<br /> EXCESS LIAB CLAIMSMADE AGGREGATE $
<br /> DED RETENTION$ $
<br /> WORKERS COMPENSATION X VVC STATU- OTH-
<br /> ' Y
<br />C AND EMPLOYERS
<br />LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE YIN CA20010955-131 7/112013 7/1/2014 E.L. EACH ACCIDENT $ 1,000,08
<br /> OFFiCERJMEMBER EXCLUDEO/
<br />(MandaWry In NH) N/A
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,00
<br /> I(describe under
<br />Drs( RIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT 1,OOQ00
<br />$
<br />A Professional Liab. FLP0045679-02 8/112013 8/1/2014 See Limits Below
<br />DESCMPMON OF OPERATIONS / LOCATIONS / VEHICLES (Aeach ACORD 101, Additional Remade Schedule, H rr apace 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 />0810112002. Professional Liabilly& Managed Care Erroll and Omissions Retroactive date: 03/0111998. 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 CANCELLATION
<br />y? /,1y 1 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 />Laura A. Rossini
<br />Assistant City Attorney AUTHORREDREPRESENTATIVE
<br />City of Santa Ana
<br />62 Civic Center Plaza
<br />Santa Ana CA 92702
<br />©1988-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 26 (2010106) The ACORD name and logo are registered marks of ACORD
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