HomeMy WebLinkAboutCARE AMBULANCE SERVICES, INC.MAYOR
Miguel A. Pulido
MAYOR PRO TEM
Michele Martinez
COUNCILMEMBERS
P. David Benavides
Vicente Sarmiento
Jose Solorio
Sal Tinajero
Juan Villegas
May 31, 2018
FILE
CITY OF SANTA ANA
Finance and Management Services Agency
20 Civic Center Piaza s P.O, Box 1964 s Santa Ana, California 92742
EniAs nta-angora
Troy Hagen, Chief Executive Officer
CARE Ambulance Service, Inc.
1517 W. Braden Court
Orange, CA 92868
A-2017-239-01
CITY MANAGER
Raul Godinez II
CITY ATTORNEY
Sonia R. Carvalho
CLERK OF THE COUNCIL
Maria D. Huizar
Re: A-2017-239, First Amendment to Emergency Transportation Agreement - Extension
Dear Mr. Hagen,
Pursuant to Agreement A-2017-239 ("First Amended Agreement"), entered into between CARE
Ambulance Service, Inc. ("Contractor") and the City of Santa Ana ("City"), dated September 5, 2017,
amending Agreement #A-2012-196, ("said Agreement") Section 5 Term, the time period of said
Agreement is hereby extended for six (6) additional months. In accordance with the provisions of
Section 5 of said Agreement, as amended by Section 2. of the First Amended Agreement, the City's
decision to grant an extension has been made with the concurrence of the Orange County Fire
Authority. The term of this extension shall begin 12 a.m. on July 1, 2018 and end on 12 a.m. January
1, 2019. The insurance certificates required pursuant Section 8 of the Agreement shall be required to
be extended and/or renewed to cover this extension. All other terms and conditions of said
Agreement remain unchanged and in full force and effect.
If you have any questions regarding this matter, please contact Willard Holt, Treasury and Customer
Services Manager in the Finance and Management Services Agency at 714-647-5456.
Sincerely,
CITY OF SANTA ANA
Raul Godinez, 11
City Manager
APPROVED AS TO FORM:
CITY ATTORNEY
Sonia R. Carvalho
`,`
Li7a E. Storck
Assistant City Attorney
w
Maria D. Huizar
Clerk of the Council
"CONTRACTOR"
CARE AMBULANCE SERVICE, INC.
.A
By:
Name: (Fray eh. �I�a�
Tale: Chief Executive Officer
SANTA ANA CITY COUNCIL
Mi"uei A. Pulltl Michele MaAe az vicanie Sarmiento Josa sdi,60 P, Davitl Benevides ,luan ViR gas Sal Tinajero
Mayor Mayor Pro Tem, Ward 2 Wardt Ward3 Wad Wards Ward6
moulid @sante ana.oro rn marfnez@sanlaana oro vsarm'snto@sant+-ana.ora apja'o@sante-ana,gig dbep3,ieg@santa-an..0 villeoas@spill-ana.ora sLaero@sante-a a'rn
Page 1 of 2
AC a® CERTIFICATE OF LIABILITY INSURANCE
ATE
D10/24/2017Y)
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($), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER,
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or 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 notoonfer rights to the certificate holder In lieu of such ondorsament a ,
PRODUCER
A
Willie of Seattle, Inc.
c/o 26 Century Blvd
ONE 1-077-945-7398 X 1-980-467-2379
'MARoXcarti£iaatea8willia. oo�el.
$.$L_
P,O, Eox 305191
INSURER(B)AFFORDINGG COVERAGE _NAIC9
Naahvillo, TN 3 7 2 3 05191 USA
_
INSURER A I Coverya specialty insurance Company 15606
INSURED
Care AAbulanoe aervi0ea, Inc.
1517 west Braden Coart
INSURER 1 Oreanwich Insurance Company 22322
INSURER C; 9teadfa3t Insurance Company 26397
_
INSURER U: XL Specialty Insurance Company 37885
Orunge, CA 92868
INSURER E:
INSURER F,
COVERAGES CERTIFICATE NUMBER: W4092490 .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,
INS
11
TYPE OF INSURANCE
AULL
B
POLICY NUI a
POLICY EFF
flD
DLG E%1+
0
LIMITS
X COMMERCIAL GENER�AL LIUIOILITY
CLAIMS-MACF. u OCCUR
EACH OCCURRENCE $ 11000,000
ES (Ea O.oEB 1,000,000
REMISE' seam aence S
MED EXP An ono Preen $ 5,000
A
X Broduats-Claime Made
y
E-10013
10/01/2011
1D/O1/2018
PERSONAL B ADV INJURY $ 1,000,000
GEN'L AGGREGATE UMIT APPLIES PER:
GENERALAGGREGATE $ 2,000,000
E]0t POLICY 5g 0 Lao
PRODUCTS -COMPIOP AGO $ 2,000,000
$
DHE:
AUTOMOBILELIABILITYIts1B
NED3INGLE LIMIT $ 1,000,000
BODILY INJURY (Per person) $
�( ANYAVTO
E
A UTO AUT06ULEO
y
RAp500047302
10/01/2017
1/01/2018
BODILY INJURY (Per accident) $
HIRED NONANNED
AUTOS ONLY AUTOSONLY
PftOPERi DAMAGE $
Per cid I
_
$
0UNIORELLALIAe
><
EXCESS LIAO
X
OCCUR
CLAIMS4,1ADE
y
UMS414770-04
10/01/2017
10/01/2018
EACHOCCURRENCE $ 15,000,000
AGGREGATE $ 15,000,000
OED I I RETENTION $
$
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANYPROPRIETORA'ARTN59RECUTIVE Y N
OFF)CERIMEMBEREXOWDED7 No
(Mandelory In NR)
NIA
RWO30009ZB-02
10/01/2017
10/01/2018
X I TA UTE E
E.L. EACH ACOIOENT 5 1, 000, 000
E.L. DISEASE• FA EMPLOYE $ 1,000,000
ff YYee deacdbo under
DES6RIPTION OF OPERATIONS below
E.L. DISEASE• POLICY LIMIT 5 1,000,000
A
Mian Medical Profedaional
5-10013
10/01/2017
10/01/2018
Par Claim $1,0001000
Liability
Aggregate S2, 000, 000
Claims Made
Abuee 6 NOIaoLa Lion $1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ADORE 101, AUditlanal Remarks Schodula, maybe attachad it more apace Is required)
Umbrella/Excea$ pollow, Vorm.
The City of Santa Ana and their rospootiva officers, officials, employees, representative and volunteers are included
as Additional Insured$ per ContraoL or Agreementa with the City of Santa Ana in accordance with the policy provisions
of the General Liability, Automobile Liability, and Umbrella/Exoeas Liability policies,
w •'- / "' SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
7HE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
The City o£ Santa Ma '/ A!p 0AUTHORIZEDREPRESENTAINE
20 Civic Center Plaza �/ 1111 (!„ e. n
01989.2515 ACORO CORPORATION. All rlchts reserved
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
OR So, 15222435 eh=a 459671
A__Zn12-ja6`02
Page 1 of 2
A ®® CERTIFICATE OF LIABILITY INSURANCE
011/29ATE I/2017V)
il/29/201T
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 pollcy(les) must have ADDITIONAL INSURED provisions or 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
ONTACT
Willis of Seattle, Inc.
c/o 26 Century Blvd
P.O. Box 305191
PRONE 1-877-845-7375 FAX 1-888-467-2378
C o:
M�FIU•
ADDRESS: Corti€i0atea@wi1119.com
INSURER(3)AFFORDING COVERAGE
NAICB
Nashville, TN 372305191 USA
INSURERA; Cove-ys Specialty Inaurance Company
15686
INSURED
INSURERBt Greenwich Insurance Company
22322
Cara Ambula.ca services, Ino.
1517 West Braden Court
—
INSURERC: steadfast Inaurance Company
26387
INSURERD: XL Specialty Insurance Company
37885
Orange, CA 92868
INSURER E;
X
MED EXP (Any one arson) $ 5,000
INSURER F: mm
Products -Claims Made
COVERAGES CERTIFICATE NUMBER: W4491393 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.
:LTR
TYPE OF INSURANCEADOL
SUBR
POLICY NUMBER
POLI YEFF
DD riI
POLICY EXP
(MMIOOYYYYI
LIMITS
X
COMMERCIALOENERAL LIABILITY
EACH OCCURRENCE S 1,000,000
CLAIMS -MADE I OCCURREMIS
T R 1,000,000
ftE SES Ea occurrence $
X
MED EXP (Any one arson) $ 5,000
A
Products -Claims Made
y
5-10013
10/01/2017
10/01/2018
PERSONAL &ADV INJURY $ 1,000,000
AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE $ 2,000,000
GEHL
X
POLICY ❑ JEC ❑ LOC
PRODUCTS -COMPIOP ADD S 2,000,000
$
OTHER:
AUTOMOBILELIASILITY
COMBINED SINGLE LIMIT $ 1,000,000
ac dent
_
BODILY INJURY(Perpersan) $
X
ANY AUTO
B
OWNED
AUTOS DONLY quTESULED
y
RAD500047602
10/01/2017
10/01/2016
BODILY INJURY( Per ecciden0 $
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
PROPERTY DAMAGE --
Per mid 1 t $
C
UMBRELLALIAB
X
OCCUR
EACH OCCURRENCE $ 15,000,0DO
AGGREGATE $ 15,000,000
X
EXCESS UAD
CLAIMS -MADE
y
UPID5414770-04
10/01/2017
10/01/2018
DED ETENTION
S
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANYPROPRIETORUPARTNERIEXECUTIVE YIN
OFFICER/MEMOEREXCLUDED7 N°
(Mandetoryin NH)
NIA
RM3000955-02
10/01/2017
10/01/2018
X I PTRTUT ERN
--
E.L. EACH ACCIDENT $ 1,000,000
E.L. DISEASE -EA EMPLOYEE $ 1,000,000
Ifyas,descdbe Littler
DESCRIPTION OF OPERATIONS below
E.L. DISEASE -POLICY LIMIT $ 1,000,000
A
Mie. Medical Professional
5-10013
10/01/2017
10/01/2018
Per Claim $1,000,000
Liability
Aggregate $2,000,000
Claims Made
Abuse S Molestation $1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 7,7-17
7
I(.Y / /_../'%
This Voids and Replaces Previously Issued Certificate Dated 10/24/2017 WITH ID: W4092490.
Umbrella/Excess Follows Form. (-n '
The City of Santa Ana and their respective officers, officials, employees, representative and volunteers are included
as Additional Insureds per Contract or Agreements with the City of Santa Ana in accordance with the policy provisions
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
Santa Ana, CA 92701
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
sa -0, 15362924 vacs: 526623
ACO/®®
lk.—/
AGENCY CUSTOMER ID:
LOC M
ADDITIONAL REMARKS SCHEDULE
Page 2 Of 2
AGENCY
NAMEDINSURED
Willis of Seattle, Inc.
Care Ambulance Services, 1.0.
1517 West Braden Court
Orange, CA 92868
POLICY NUMBER
See Page 1
CARRIER
NAIL CODE
See Page 1
Sae Page 1
EFFECTIVE DATE: See Page 1
The ACORD name and logo are registered marks of ACORD
SR IO: 15362924 BATCH, 576623 CERT: W4491393
COVER,YS®°, , "
INSURANCE COMPANY
AMENDMENT TO THE DEFINITION OF INSURED
Attachad to and forming First Named Insured:
part of Policy Number:
Policy Period:
5-10013 Fatek USA, Inc.; Care Ambulance Services
110/1/2017 —10/1/2018
Policy Number:
First Named Insured:
Policy Period:
Effective Date of Change:
510013
Feick USA, Inc,; Care Ambulance Services
101112017-10/1/2018
10/1/2017
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the following:
Commercial General Liability Coverage Part— Occurrence Coverage Form
SCHEDULE
Name of Person or
Party ID (if
Retroactive Date
Activities
Organization
applicable)
(if applicable)
The City of Santa Ana, its
n/a
n/a
Ambulance service as described in contract
officers, employees, agents,
volunteers and
representatives
Subject to all other terms and conditions of the POLICY, it is agreed and understood that Section II. Definition of
Insured is amended to include as an INSURED the Person(s) or Organization(s) shown in the Schedule above, but
only with respect to the activities indicated above.
This additional Insured shall share in the Limits of Liability of the FIRST NAMED INSURED, and this extension of
coverage shall not increase OUR Limit of Liability.
We agree to notify the Named Person or Organization in writing at least thirty (30) days in advance of cancellation
of this policy.
Nothing in this endorsement shall vary, alter, waive or extend any of the terms and conditions of the POLICY, other
than as expressly stated above.
A
Sam Mezzich Richard G. Hayes
President Treasurer
i
Activity No:
COM 003 CS 03/15 Date Produced: 10/09/2015 Page 1
POLICY NUMBER: RADS00047602
COMMERCIAL AUTO
CA 20 48 10 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Alt
This endorsement modifies insurance provided under the following:
AUTO DEALERS COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by
this endorsement.
This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under
the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the
Coverage Form.
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated
below.
Named Insured: FALCK USA, Inc.
Endorsement Effective Date: October 1, 2017
SCHEDULE
Name Of Person(s) Or Organization(s):
Where required by written contract executed prior to loss.
Schad
Each person or organization shown in the Schedule is
an "insured" for Covered Autos Liability Coverage, but
only to the extent that person or organization qualifies
as an "insured" under the Who Is An Insured provision
contained in Paragraph A.I. of Section II — Covered
Autos Liability Coverage in the Business Auto and
Motor Carrier Coverage Forms and Paragraph D.2. of
Section I — Covered Autos Coverages of the Auto
Dealers Coverage Form.
CA 20 4810 13 0 Insurance Services Office, Inc., 2011
1117-"`f%7
`nrn`
Page 1 of 1"
Endorsement # 27
General Purpose Endorsement
ZURICH
Policy No.
I Of. Date of Pol.
Exp. Dale of Pol.
Eff. Date of End.
Producer
Add'I Prem.
Return Prem.
UMB 5414770-04
October 1, 2017
October 1, 2018
October 1, 2017
18501000
---
---
Named Insured and Mailing Address:
Feick USA, Inc.
2154030th Drive SE, Ste. #250
Bothell, WA 98021
Producer:
Willis of Seattle, Inc.
505 Fifth Avenue South, Ste. 200
Seattle, WA 98104
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the following:
HEALTH CARE EXCESS LIABILITY POLICY
Paragraph 3. Persons or Entitles Insured of Section II: General Policy Provisions is amended to include as an
additional insured the person or organization shown in the Schedule of this endorsement, whom you are required to add
as an additional Insured on this policy under a written contractor written agreement. Such person or organization is an
additional Insured but only because of liability caused in whole or in part by your acts or omissions. The insurance
provided by this endorsement will not be broader than that provided by the "governing underlying insurance policy'.
Subparagraph D., Cancellation, of Paragraph 6., Conditions, is amended to include the following:
If we cancelthis Insurance by written notice to the first "Named Insured" for any reason other than nonpayment of
premium, we will provide 30 -day written notice to the additional Insured listed in the Schedule below. However, this
advance notification of pending cancellation of coverage Is intended as a courtesy only and our failure to provide such
advance notification will not extend the effective date of cancellation nor negate cancellation of this Insurance.
Subparagraph M., Transfer of Any "Insured's" Rights and Duties, of Paragraph 6., Conditions, is amended to include
the following:
If the first "Named Insured" is required by written contractor agreement with the person or organization shown in the
Schedule below to waive its rights of recovery, we agree to waive our rights of recovery. This waiver of rights only applies
to the extent required by written contract, however, the contract must be entered into prior to the "occurrence" or "medical
incident" that gives rise to a claim and shall not be construed to be a waiver with respect to any other operations in which
the first "Named Insured" has no contractual interest.
SCHEDULE
Name of Person or Organization (Additional Insured): City of Santa Ana
ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED.
OVED
A( -5/s PkIi?, u b7.
S
U-HCU-405-A CW (2110)
Page 1 of 1
Page 1 of 2
ACO 0 CERTIFICATE OF LIABILITY INSURANCE
010/24/2017"
THIS CERTIFICATE 1S 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 pollcyiles) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain pollclas may require an endorsement, A statement on
this certificate does not confer rights to the certificate holder hl (leu of auch ondorsement s .
PRODUCER
CONTACT
Willis of 9oattlo, Inc.
a/o 26 Century Blvd
B.P. Box 305191
AR
PHONE1^888^467-2978
1' 1-871-948-7378 €AIC Noy
M�mcertificates6willis.com
INSURER(B) AFFORDING COVERAGE
�NAICY
Nashville, TN 372308191 USA
INSURER A Coverys specialty Insurance Company
15686
EACH OCCURRENCE
_
INSURED
INSURER d1 Greenwich Insurance Company
22322
Care Ambulenoe services, Inc.
1517 west eradan Court
INSURER C; Steadfast Insurance Company
26387
INSURER D: XL Specialty Insurance Company
37885
cranes, CA 92868
INSURER E1
MED EXP (Ay oneperson)
$ 5,000
INSURER PI
Mad.
COVERAGES CERTIFICATE NUMBERI W4092490 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 MICH 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.
ILT
TYPED? INSURANCEAUUL
R
POLICY NUMBER
POLpGY EFF
POLIO E%P
LIMITS
MMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
S 1,000,000
CLAIMS.MALIE FV-11OCCURP
tXV]ductfi-claima
EMI5E oemr
8 1,000,000
MED EXP (Ay oneperson)
$ 5,000
A
Mad.
y
5-10013
10)01/2017
10/01/2018
PERSONAL aAOV INJURY
8 1,000,000
GEHL AGGREGATE LIMIT APPLIES PER:
GENCRALAGGREGATE
$ 2,000,000
X POLICY ❑ jEpGT 0 LOC
PRODUCTS -COMPtOPAGG
S 2,000,000
S
O 11ER'
AUTOMOBILE LIABILITY
C 18 OSINGLE LIMIT
S 1,000,000
GORILY INJURY (Per pamen)
$
X ANYAUTO
B
A TUTU EDONLY SCHEDULED
Y
PADE00047602
10/01/2017
10/01/2015
BODILY INJURY (Par accoonq
S
HIRED NON-0Mal)
AUTOS ONLY AUTOOONLY
ROPERT DAMAGE
r=DAMAGE
Per
S
S^
C
,1(
UMDRELLALIAB
RODEOS LIAR
X
OCCUR
OLAIMSAIADE
y
01165414770-04
10/01/2017
10/01/2018
CACHOCCURRENCE
$ L5, ORO, UUO
AGGREGATE
4 15,000,000
DED I I RETENTION
S
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANYPROPRIETORIPARTNERI58RCUTIVE YIN
OFPICERIMEMBEREXOLVOE07 No
(MandetOgM NH)
NIA
AN03000955-02
10/01/2017
10/01/2018
T
X PTATUTE ER
E.L. EACH ACCIDENT
$ 1, 000, 000
E.., DISEASE -EA EMPLOYEE
S 11000,00
E.L. DISEASE- POLICY LIMIT
$ 1,000,000
II yyes, tlesmla order
pESCR PTION OFF OPERATIONS bel !
A
)Ais. Hadical Professional
5-10013
10/01/2017
10/01/2018
Por Claim
81,000,000
Liability
Aggregate
82,000,000
Claims Had.
Abuse S Molestation
81,000,000
DESCRIPTION OPOPBRATIONB I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Saheduls, maybe aRachad it more space is mqulrod)
Crabralla/EXOeS5 Ir011cws Bloom.
The City of Santa Ana and their raepootive officers, officials, employees, rapreeentative and volunteers are included
as Additional Insureds per Contract or Agreements with the City of Santa Ana in accordance with the policy provisions
of the General Liability, Automobile Liability, and Umbrella/Gxoeroa Liability policies.
"-/7 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
7HE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
The City of Sento Ma /q s, �e r,!! AUTHORIZED REPRESENTATIVE
20 Civic Center Plaza c -C /
Santa Ane, CA 92701
(c)1988-2015 ACORD CORPORATION. All rlahts reserved.
ACORD 26 (2016/03) The ACORD name and logo are registered marks of ACORD
OR %D: 15222435 ZhecH, 489677