ST. JOSEPH HEALTH SYSTEM 1 - 2016

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ACOR ®® � CERTIFICATE OF LIABILITY INSURANCE page 1 of 2 DATE (MMIDM YYY) 07/01/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT Willis Management (Bermuda) Limited 58 Par -la -Ville Road PHONE FAX 877- 945 -7378 888 - 467 -2378 E -MAIL certificates ®W11119.COm P. 0. Box 1995 Hamilton y y Bermuda, HM HX INSURER(S)AFFORDING COVERAGE NAIL# INSURERA: American Unity Group Limited C0929 -001 INSURED St. Joeeph Health System INSURERS: INSURERC: S 3345 Michelson Drive, Suite 100 Irvine, CA 92612 INSURER C INSURER E: INSURER F: PERSONAL It ADV INJURY COVERAGES CERTIFICATE NUMBER: 23354500 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ITS TYPE OF INSURANCE DDL SUB POLICY NUMBER POLICY EFF POLICY EXP LIMITS Santa Ana, CA 92701 -4637 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR y y UNICGLIS01031 6/30/2015 6/30/2016 EEoAAqCC�HHq(O;ppCrCrURRENCE $ 11000,000 YNEMISES eoccuredo.) $ MED EXP (Any one person) S PERSONAL It ADV INJURY $ 11000,000 GEN'LAGGREGATE LIMIT APPLIES PER: X POLICV ❑ PRO- JECT ❑ LOC GENERALAGGREGATE $ 2,000,000 PRODUCTS- COMPIOPAGG $ $ OTHER: AUTOMOBILE LIABILITY (EareddentSINGLE LIMIT $ BODILY INJURY(Per person) $ ANYAUTO ALLOWNED SCHEDULED AUTOS AUTOS ( er acc ) BODILY? NJURYPident $ HIREDAUTOS NON -OWNED AUTOS PROPERTY DAMAGE (pare.. Want) $ A X UMBRELLALIAB X OCCUR UNIUMB1501028 6/30/2015 6/30/2016 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 EXCESS LIAB CLAIMS -MADE BED I RETENTION$ $ WORKERS COMPENSATION - PER UER ANDEMPLOYERS'LIABILITY YIN ANY PROPRIETOWPARTNERIEXECUTIVE❑ NIA E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? 'Mandatory is NH) f yes, describe under E. L. DISEASE - EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E. L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Right of Entry Permit for 203 -205 West Civic Center Drive, Santa Ana, CA commonly know as the YMCA Building. The City, and its respective elected and appointed officials, officers, employees, agents and representatives are included as Additional Insureds as respects to General Liability when equired by written contract. M•. S g /� CERTIFICATE HOLDER CANCELLATION I Coll:4720652 Tpl:1973414 Cert:23954500 © 1988 -20'14 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE The City of Santa Ana 20 Civic Center Plaza Santa Ana, CA 92701 -4637 I Coll:4720652 Tpl:1973414 Cert:23954500 © 1988 -20'14 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD