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CERTIFICATE OF LIABILITY INSURANCE <br />DAR 1161 Y1 1. <br />11/01/2017 <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: N the certificate holder is an ADDITIONAL INSURED, the pollcy(les) must have ADDITIONAL INSURED provisions or be endorsed. <br />H 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 rlahts to the certificate holder In lieu of such andorsemant)s}. <br />PRODUCER <br />Andrew Atsaves ERM <br />do Arlex Risk Solutions, Inc. <br />8840 E. Chaparral Rd.; Suite 275 <br />Scottsdale, AZ 85250 <br />INSURED <br />Employers Resource of America Inc Labor Contractor, for oo-employees of: Gary A <br />Unnemann, M.D., Inc. dba: Pacific Medial Cllnlc <br />1301 S Vista Ave #250 <br />Boise, ID 85705 <br />775-ZW <br />fYfdM&CFR CFRTWICATE NLIMNIER:171DO136910761 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 SEEN REDUCED BY PAID CLAIMS. <br />T <br />TYPEOFINSURANCE <br />POLICY NUMBER <br />LIMITS <br />COMMERCIAL GENERAL LUUKLITY <br />CLAIMSMAOE E' OCCUR <br />EACH OCCURRENCE S <br />MEOEXP ane on $ <br />PERSONAL a ADV INJURY I <br />OE1fL AGGREGATE LIMIT APPLIES PER: <br />POLICY JR ❑Lac <br />OTHM <br />GENERALAGGREGATE $ <br />PRODUCTS -COMPIOP AGG S <br />$ <br />AUTOMOI NJE LIABILITY <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOSONLY AUTOS <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />a�LE LIMIT $ <br />BODILY INJURY (Per person) $ <br />BODILY INJURY (Paratidanl) $ <br />PROPERTY OAMAOE S <br />$ <br />UMBRELLA LIAB <br />EXCESS UAB <br />OCCUR <br />CLAIMS -MADE <br />EACH OCCURRENCE $ <br />AGGREGATE $ <br />DED I I RETENTIONS <br />$ <br />WORKERSCOMPENSATION <br />ANO EMPLOYERS' LIABILITY <br />ANYPROPRIETORIPARTNERIEXECUTNE YIN <br />A OFFICERIMEMBERE](CLUDED'I <br />(Mendnlory In NH) <br />Hyyeese d;' -%=N under <br />DESCRIPTIprI OF OPERATION$ loolour <br />NIA <br />WC U2-7$-811.02 <br />D7/D1i2D17 <br />07/01!2018 <br />X I SPEAr'T.T. <br />E.L. EACH ACCIDENT $ 1,000,000 <br />E.L.DISEASE-EAEMPLOYE $ 1000000 <br />E.L. DISEASE -POLICY LIMIT $ 1.00% 000 <br />Location Coverage Period: <br />07/01/2017 <br />07/01/2018 <br />Client# 642191 -CA <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACDRO 101, Additional Remade Schedule, over he atached K mom space is mislead) <br />coverage is provided for Gary A. Linnemann, M.D., Inc. d34a: Pacific Medical Clinic <br />only those co-empioyaor 15 E Warner AveAVe Ste A <br />of, but W subcontractors Santa Ana, CA 92705 <br />to: <br />Gary A. Linnemann, M.D., Inc. <br />dba: Pacific Medical Clinic <br />1534 E Wamer Ave <br />Ste A <br />Santa Ana, CA 92705 <br />CANCELLATION <br />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 />AUTNONcMDD REPRV NNTA" <br />®1988.2015 ACORD CORPORATION. All <br />ACORD 25 (2016/031 The ACORD name and loco are reatstered marks of ACORD <br />