ST. JOSEPH HEALTH SYSTEM 1 - 2016

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A� 'a CERTIFICATE OF LIABILITY INSURANCE 6/23/2015 ' THIS CERTIFICATE IS ISSUED A$ 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 Sanford & Tatum Insurance Agency 6303 Indiana Ave. P.O. Box 64790 Lubbock TX 79464 CONTACT Tammy Dipp21_ PaoNE . (806)792• -5564 FAX (806)992 -9349 EMAIL fordtatu. acct ADDRESS: di pp eltpsan m INSURERS AFFORDING COVERAGE NAIC If INSURERA:Zurich Commercial 16535 0003 INSURED St Joseph Health System 3345 Michelson Suite 100 Irvine CA 92612 INSURER B: _ INSURER 0: V � INSURER D: INSURER E: $ INSURER P: COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑ OCCUR COVERAGES CERTIFICATE NUMBER.15 -16 St Joseph 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. ILTR TYP OFINSURANCS E ADDL &UDR POLICY NUMBER POLICYEFF MIDD POLICY EXP MMIDDIYYYY LIMITS Douglas Sanford/,TRW —�•d- -t- GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑ OCCUR DAMA SiE TO HEWIED $ MED EXP(Any one person ) $ PERSONAL &ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER; PRODUCTS- COMPIOPAGG $ POLICY PRO LOC ECT �Y $ AUTOMOBILE LIABILITY X EeeBB tle DSINGLE LIMIT $ 11000 ,000 BODILY INJURY (Per person) $ A X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS AR9300970 -14 6130/2015 6/3012016 BODILY INJURY (POT a0ddent) $ PPe�acGtlenlI MA $ X HIRED AUTOS X AU OS ED Uninsured Motorist combined $ 1,000,0001 UMBRELLA LIPS OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIA13 CLAIMS -MADE DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY FFICERlMEMBER EXCLUDED ?ECUTIVE❑ NIA TOM, STATU- I OTH. E E.L. EACH ACCIDENT 8 E.L. DISEASE - EA EMPLOYEE S (Mandatary In NH) If yes, desotlbe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Hired Physical Damage AE9300970 -14 6/30/2015 6/30/2016 $M0 Deductible Comprehensive $65,000.00 $1,000 Deductible Collision DESCRIPTION OF OPERATIONS :LOCATIONS [VEHICLES (Aaach ACORD ID1, Adtliflsnal Remarks SChetlule, if more space is required) Re: Right of Entry Permit for property located at 203 -205 West Civic Centex Drive, Santa Ana, CA, YMCA Building. The City, and its respective elected and appointed officials, officers, employees, agents and _✓J representatives are named as Additional Insured when required by written aontrai I /0/4 CERTIFICATE HOLDER CANCELLATION ACORD 26 (2010 @6) ©1908.2010 ACORD CORPORATION. All rights reserved. INS025 (201005).01 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. The City of Santa Ana 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana, CA 92701 -4637 Douglas Sanford/,TRW —�•d- -t- ACORD 26 (2010 @6) ©1908.2010 ACORD CORPORATION. All rights reserved. INS025 (201005).01 The ACORD name and logo are registered marks of ACORD