|
CERTIFICATE OF LIABILITY INSURANCE
<br />-- "�
<br />DATE(MMIDDPIYYYI
<br />09129/2016
<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 have ADDITIONAL INSURED provisions or be endorsed,
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />VIG, LLC., d1lalThe Vestavia Group
<br />2030 Columbiana Road, Suite 4400 p � ,"
<br />Birmingham, AL 35216 — `� °'�
<br />CONTACT
<br />NAME;
<br />PRONE 205 -552 -0244 arc No 1105-244-'072
<br />E MAIL
<br />ADDRESS: susan,Crain veslaViagrOUp.com
<br />CNSURER'S AFFORDING - OVERAGE
<br />NAICq
<br />INSURE"- Pro Assurance Casualt COm an "A + "' XII
<br />3'5954
<br />A
<br />INSURED
<br />NaphCare, Inc.
<br />2090 Columbiana load, Suite 4000
<br />INSURER B : The Travelers Insurance Company "A'. "' X'V
<br />19046
<br />INSURERC:
<br />ES1B40
<br />INSURER D.
<br />09/30/17
<br />INSURER E;
<br />$ 1,000,000
<br />Birmingham AL 35216
<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 />ILTR
<br />TYPE OF INSURANCE
<br />IN L
<br />POLICY NUMBER
<br />MMPDDY E'FF
<br />MRIIDDY EXP
<br />LIMITS
<br />A
<br />CO'MMERCLALGENERA.LLIA,BILITY
<br />PI
<br />ES1B40
<br />09/30/16
<br />09/30/17
<br />EACH OCCURRENCE.
<br />$ 1,000,000
<br />CLAIMS•MADE A I OCCUR
<br />I
<br />A
<br />PREMISES Ea occurrence
<br />.
<br />$ 50,000
<br />MHD EXP (Any one porsor )
<br />$ 5,000
<br />PERSONALBADVPNJURY$
<br />1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER.
<br />PRO•
<br />E
<br />GENERAL AGGREGATE
<br />$ 5,000,000
<br />PRODUCTS - CCMPlCPAGC
<br />$ 1,000,000
<br />POLICY JECT 0 LOC
<br />$
<br />OTHER:
<br />AUTOMOSILELIABILITY
<br />Not Applicable
<br />CCMBIN'ED SINGLE LIMIT
<br />Ea accident
<br />$ X X.X.......
<br />ANY AUTO
<br />BODILY INJURY (Per Person)
<br />_
<br />S , },xxxx '...
<br />OWNED SCHEDULED
<br />AUTOSONLY AUTOS
<br />BODILY INJURY (Peraccident)
<br />$ XXXXXX.
<br />HIRED NON-OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PR(IPERTYDAMAGE
<br />I Per accident
<br />$ XXXXXX.
<br />S
<br />UMBRELLALIAB
<br />OCCUR
<br />Not Applicable
<br />EACH OCCURRENCE
<br />$ XXXXXX..
<br />EXCESS UAR
<br />..CLAIMS-MACE
<br />AGGREGATE
<br />$ XXXXIUC
<br />DEO I RETENTIONS
<br />$.
<br />B
<br />WORKERS COMPENSATION
<br />N
<br />TC2IyIt B- 425IB723 -16
<br />09130/16
<br />09130/17
<br />X STATUTE EHH
<br />AND EMPLOYERS' LIABILITY YIN
<br />'RGPRkETORIPARTNER/EXECUTIVE
<br />TROUBA25IB760 -16
<br />E.L. EACH ACCIDENT
<br />s
<br />ANYP
<br />OFFICEFUMEMBEREXCLUDED? ��}^+�'��
<br />NIA
<br />E.L. DISEASE • EA EMPLOYEE
<br />S 1,000,000
<br />Ifgys, (Mandatory describe under NMI
<br />E.L. DISEASE •POLICY LIMIT
<br />$ 1,000,000
<br />LiESCRIPTION O OPERATIONS belovr
<br />A
<br />Professional Liability
<br />Y
<br />N
<br />ES1840
<br />09/30/11'09/30/17
<br />Each Med. Incide
<br />t $1,000,000
<br />Claims Made
<br />Ann. Aggregate $5,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES ( ACORD 101, Addt lonal Remarks Schedule, may attached Il�rnore apace Is required)
<br />The City of Santa Ana is named as Additional Insured as respects liability. Policies will not be Cancelled or
<br />materially modified with providing thirty (30) days written notice to the City„ f1
<br />_,. w.a ... ..
<br />I
<br />4HIVr,.CILL.Ft I IVI I
<br />City of Santa Ana
<br />Department ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Attn: Purchasing Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />22^0 Civic Center Plaza ACCORDANCE WITH THE POLICY PROVISIONS
<br />Santa Ana, CA. 92701 01 AUTHORIZ DREPRESENTATIVE
<br />dc'i rr,
<br />U/, C:c -FZ"
<br />031988 -2015 ACCORD CORPORATION. All rights reserved.
<br />AUU110 25 (2016,103) The ACORD name and logo are registered marks of ACORD
<br />
|