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HomeMy WebLinkAboutPACIFIC MEDICAL CLINIC 2AMAYOR MAR 1.8 2014 Miguel A. Pulido 0 � }� rsonmil (,1) MAYOR PRO TEM Mckry Sal Tinajero COUNCILMEMBERS Angelica Amezcua P. David Benavides Michele Martinez Roman Reyna Vincent F. Sarmiento March 7, 2014 CITY OF SANTA ANA PERSONNEL SERVICES AGENCY 2.0 Civic Center Plaza - PO Box 1988 Santa Ana, California 92702 www.santa- ana.org Dr. Gary Linnemann, M.D. 1534 East Warner Avenue, Suite A Santa Ana, CA 92705 Subject: Medical Services Provided to City of Santa Ana, as per Agreement N- 2013 -142 Dear Dr. Linnemann: N- 2013 -142 -001 CITY MANAGER David Cavazos CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar � r•�yh According to Section 3 - "Term" of Agreement N- 2013 -142, the existing Agreement may be extended upon a writing executed by the executive Director of the Personnel Services Department and the City Attorney. Pursuant to this section, the time period of the agreement is hereby extended from June 30, 2014 to June 30, 2015. The provisions outlined in Section 5 - "Insurance" remain the same; please ensure relevant insurance certificates are extended or renewed to cover this extension. Apart from the change to Section 3, all other terms and conditions of the original agreement remain unchanged and in full force and effect. If you have any questions, please contact Mary Kelley at (714) 647 -5347. Sincerely, Edward S. Raya, Executive Director - Personnel Services ATTEST: 'f'lLst ,-) .t,5;, Maria D. Huizar Clerk of the Council /oseA Straka Senior Assistant City Attorney SANTA ANA CITY COUNCIL Miguel A. Pulido Sal Tinajero Vincent F. Sarmiento Michele Martinez Angelica Amezcua P. David Benavides Roman Reyna Mayor Mayor Pro Tem, Ward 6 Word Word Ward Word Ward5 PAPU11do @santa- ana.ore ST na'ero @sarta- ana.ore VSarm ento @sania- ana.ore MMartinex @santa- ana.ore AAmezcua @sama- ana.ore � DBenavWaz @santa-anaorg RRevna5lsanta- ana.ore 4` ou °® CERTIFICATE OF LIABILITY INSURANCE 6 /,2 `20., '" 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 Insurance Solutions License #0746539 33302 Valle Rd, Suite 200 San Juan Capistrano CA 92675 CONTACT Sara Donohoe NAME: —FAX PHDNE . (949)348 -7400 0:(949)340 -2373 EMAIL SaraD@Tns- solutions.com AODR S' INSURERS AFFORDING COVERAGE NAICM INSURERAAmco Insurance Co 19100 INSURED DR GARY A LINNEMANN MD 1534 E WARNER AVE STE A - SANTA ANA CA 92705 -5475 INSURERS: 6/6/2013 INSURERC: EACH OCCURRENCE INSURER D: PAEMGES —RE ace INSURER E: MEO EXP(Any one person) 1 INSURER F: PERSONAL &ADV INJURY COVERAGES CERTIFICATE NUMBER:13 /14 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, IN$R TR TYPE OF INSURANCE INSR SUDR POLICY NUMBER MMIOD�Y MMIDDIYYVY. LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR T Alessandra /PETERS CP7881875918 6/6/2013 6/6/2014 EACH OCCURRENCE $ 1.000,000 PAEMGES —RE ace $ 300.000 MEO EXP(Any one person) S 5,000 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 CARL AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC PRODUCTS - COMPIOP AGO $ 2,000,000 $ P' POMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIREDAUTOS X' AUTOS CP7881875918 6/6/2013 6/6/2014 Ee aocdeOtSINGLE LIMIT $ 11000,000 BODILV INJURY (Per person) $ BODILY INJURY (Per accitlent) $ PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS_ MADE y� (\'�F" p'QrR F ^ VV I ® EACH OCCURRENCE $ AGGREGATE $ 'DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY ANY PROPRIETOR /PARTNERIE%ECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) It yes, describe under DESCRIPTION OF OPERATIONS below NIA * ($ S ®$C{ ♦ t j$`� st'ra..Ney \w �� L'M ¢} / WC STATU- OETH- TORY E.L. EACH ACCIDENT $ E.L. DISEASE - FA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The City of Santa Ana, its officers., employees, agents and volunteers are named as additional insured per the Commercial General Liability Coverage Form CG 00 Ol 12 07 attached to the policy. CERTIFICATE HOLDER CANCELLATION MKelleyOsanta- ana.org SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Santa Ana 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana, CA 92702 T Alessandra /PETERS ACORD 25 (2010105) INS025 ronlnnel m © 1988 -2010 ACORD CORPORATION. All rights reserved. The ArtIDPF) name cnd Innn arc ronict.,.,I mcrk,c of Ar.OPM M Conduct and control the defense of the indemnitee in such "suit ". So long as the above conditions are met, attor- neys' fees incurred by us in the defense of that in- demnitee, necessary litigation expenses incurred by us and necessary litigation expenses incurred by the indemnitee at our request will be paid as Supplementary Payments. Notwithstanding the provisions of Paragraph 2,b.(2) of Section I — Cov- erage A — Bodily Injury And Property Damage Li- ability, such payments will not be deemed to be damages for "bodily injury" and "property damage" and will not reduce the limits of insurance. Our obligation to defend an insured's indemnitee and to pay for attorneys' fees and necessary litiga- tion expenses as Supplementary Payments ends when we have used up the applicable limit of in- mumse in the payment of judgments e, or tle- ments or the conditions set forth above, or the terms of the agreement described in Paragraph f. above, are no longer met. SECTION II — WHO IS AN INSURED 1. If you are designated in the Declarations as: a. An individual, you and your spouse are insur- eds, but only with respect to the conduct of a business of which you are the sole owner. b. A partnership or joint venture, you are an in- sured. Your members, your partners, and their spouses are also insureds, but only with re- spect to the conduct of your business. c. A limited liability company, you are an insured. Your members are also insureds, but only with respect to the conduct of your business. Your managers are insureds, but only with respect to their duties as your managers. d. An organization other than a partnership, joint venture or limited liability company, you are an insured. Your "executive officers" and directors are insureds, but only with respect to their du- ties as your officers or directors. Your stock- holders are also insureds, but only with respect to their liability as stockholders, e. A trust, you are an insured. Your trustees are also insureds, but only with respect to their du- ties as trustees. CG 00 01 12 07 CG 00 01 12 07 2. Each of the following is also an insured: a. Your "volunteer workers" only while performing duties related to the conduct of your business, or your "employees ", other than either your "executive officers" (if you are an organization other than a partnership, joint venture or limited liability company) or your managers (if you are a limited liability company), but only for acts within the scope of their employment by you or while performing duties related to the conduct of your business. However, none of these "em- ployees" or "volunteer workers" are insureds for: (1) "Bodily injury" or "personal and advertising injury": (a) To you, to your partners or members (if you are a partnership or joint venture), to your members (if you are a limited li- ability company), to a co- "employee" while in the course of his or her em- ployment or performing duties related to the conduct of your business, or to your other "volunteer workers" while perform- ing duties related to the conduct of your business; (b) To the spouse, child, parent, brother or sister of that co- "employee" or "volun- teer worker" as a consequence of Para- graph (1)(a) above; (c) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraphs (1)(a) or (b) above; or (d) Arising out of his or her providing or failing to provide professional health Care services. (2) "Property damage" to property: (a) Owned, occupied or used by, (b) Rented to, in the care, custody or con- trol of, or over which physical control is being exercised for any purpose by you, any of your "employees ", "volunteer workers ", any partner or member (if you are a partnership or joint venture), or any mem- ber (if you are a limited liability company). Page 9 of 16 t 00 01 12 07 b. Any person (other than your "employee" or "volunteer worker "), or any organization while acting as your real estate manager. c. Any person or organization having proper temporary custody of your property if you die, but only: (1) With respect to liability arising out of the maintenance or use of that property; and (2) Until your legal representative has been appointed. d. Your legal representative if you die, but only with respect to duties as such. That represen- tative will have all your rights and duties under this Coverage Part. 3. Any organization you newly acquire or form, other than a partnership, joint venture or limited liability company, and over which you maintain ownership or majority interest, will qualify as a Named In- sured if there is no other similar insurance avail- able to that organization. However: a. Coverage under this provision is afforded only until the 90th day after you acquire or form the organization or the end of the policy period, whichever is earlier; b. Coverage A does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization; and c. Coverage B does not apply to "personal and advertising injury" arising out of an offense committed before you acquired or formed the organization. No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations. SECTION III — LIMITS OF INSURANCE The Limits of Insurance shown in the Declarations and the rules below fix the most we will pay re- gardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits ". 2. The General Aggregate Limit is the most we will pay for the sum of: a. Medical expenses under Coverage C; b. Damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "products- completed operations hazard ": and c. Damages under Coverage B. 3. The Products- Completed Operations Aggregate Limit is the most we will pay under Coverage A for damages because of "bodily injury" and "property damage" included in the "products- completed op- erations hazard ". 4. Subject to Paragraph 2, above, the Personal and Advertising Injury Limit is the most we will pay un- der Coverage B for the sum of all damages be- cause of all "personal and advertising injury" sus- tained by any one person or organization. 5. Subject to Paragraph 2. or 3. above, whichever applies, the Each Occurrence Limit is the most we will pay for the sum of: a. Damages under Coverage A; and b. Medical expenses under Coverage C because of all "bodily injury" and "property dam- age" arising out of any one "occurrence ". 6. Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of "property damage" to any one premises, while rented to you, or in the case of damage by fire, while rented to you or temporarily occupied by you with permission of the owner. 7. Subject to Paragraph 5. above, the Medical Ex- pense Limit is the most we will pay under Cover- age C for all medical expenses because of "bodily injury" sustained by any one person. The Limits of Insurance of this Coverage Part apply separately to each consecutive annual period and to any remaining period of less than 12 months, starting with the beginning of the policy period shown in the Declarations, unless the policy period is extended after issuance for an additional period of less than 12 months. In that case, the additional period will be deemed part of the last preceding period for purposes of determining the Limits of Insurance. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS 1. Bankruptcy Bankruptcy or insolvency of the insured or of the insured's estate will not relieve us of our obliga- tions under this Coverage Part. 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit a. You must see to it that we are notified as soon as practicable of an "occurrence" or an offense which may result in a claim. To the extent pos- sible, notice should include: (1) How, when and where the "occurrence" or offense took place; (2) The names and addresses of any injured persons and witnesses; and Page 10 of 16 CG 00 01 12 07 CG 00 01 12 07 (3) The nature and location of any injury or 4. Other insurance damage arising out of the "occurrence" or if other valid and collectible insurance is available offense, to the insured for a loss we cover under Cover - b. If a claim is made or "suit" is brought against ages A or B of this Coverage Part, our obligations any insured, you must: are limited as follows: (1) Immediately record the specifics of the claim or "suit" and the date received; and (2) Notify us as soon as practicable. You must see to it that we receive written no- tice of the claim or "suit" as soon as practica- ble. c. You and any other involved insured must: (1) Immediately send us copies of any de- mands, notices, summonses or legal pa- pers received in connection with the claim or "suit"; (2) Authorize us to obtain records and other information; (3) Cooperate with us in the investigation or settlement of the claim or defense against the "suit "; and (4) Assist us, upon our request, in the en- forcement of any right against any person or organization which may be liable to the insured because of injury or damage to which this insurance may also apply. d. No insured will, except at that insured's own cost, voluntarily make a payment, assume any obligation, or incur any expense, other than for first aid, without our consent. 3. Legal Action Against Us No person or organization has a right under this Coverage Part: a. To join us as a party or otherwise bring us into a "suit" asking for damages from an insured; or b. To sue us on this Coverage Part unless all of its terms have been fully complied with. A person or organization may sue us to recover on an agreed settlement or on a final judgment against an insured; but we will not be liable for damages that are not payable under the terms of this Coverage Part or that are in excess of the ap- plicable limit of insurance. An agreed settlement means a settlement and release of liability signed by us, the insured and the claimant or the claim- ant's legal representative. a. Primary Insurance This insurance is primary except when Para- graph b. below applies. If this insurance is pri- mary, our obligations are not affected unless any of the other insurance is also primary. Then, we will share with all that other insur- ance by the method described in Paragraph C. below. b. Excess Insurance (1) This insurance is excess over: (a) Any of the other insurance, whether primary, excess, contingent or on any other basis: (i) That is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for "your work "; (ii) That is Fire insurance for premises rented to you or temporarily occu- pied by you with permission of the owner; (iii) That is insurance purchased by you to cover your liability as a tenant for "property damage" to premises rented to you or temporarily occu- pied by you with permission of the owner; or (iv) If the loss arises out of the mainte- nance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of Section I — Coverage A — Bodily Injury And Property Dam- age Liability. (b) Any other primary insurance available to you covering liability for damages aris- ing out of the premises or operations, or the products and completed operations, for which you have been added as an additional insured by attachment of an endorsement. (2) When this insurance is excess, we will have no duty under Coverages A or B to defend the insured against any "suit" if any other insurer has a duty to defend the insured against that "suit ". If no other insurer de- fends, we will undertake to do so, but we will be entitled to the insured's rights against all those other insurers. CG 00 01 12 07 Page 11 of 16 CG 00 01 12 07 (3) When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (a) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (b) The total of all deductible and self - insured amounts under all that other in- surance. (4) We will share the remaining loss, if any, with any other insurance that is not de- scribed in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. c. Method Of Sharing If all of the other insurance permits contribution by equal shares, we will follow this method also. Under this approach each insurer con- tributes equal amounts until it has paid its ap- plicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. 5. Premium Audit a. We will compute all premiums for this Cover- age Part in accordance with our rules and rates. b. Premium shown in this Coverage Part as ad- vance premium is a deposit premium only. At the close of each audit period we will compute the earned premium for that period and send notice to the first Named Insured. The due date for audit and retrospective premiums is the date shown as the due date on the bill. If the sum of the advance and audit premiums paid for the policy period is greater than the earned premium, we will return the excess to the first Named Insured. c. The first Named Insured must keep records of the information we need for premium computa- tion, and send us copies at such times as we may request. 6. Representations By accepting this policy, you agree: a. The statements in the Declarations are accu- rate and complete; b. Those statements are based upon representa- tions you made to us; and c. We have issued this policy in reliance upon your representations. 7. Separation Of Insureds Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this Coverage Part to the first Named Insured, this in- surance applies: a. As if each Named Insured were the only Named Insured; and b. Separately to each insured against whom claim is made or "suit" is brought. 8. Transfer Of Rights Of Recovery Against Others To Us If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The in- sured must do nothing after loss to impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. 9. When We Do Not Renew If we decide not to renew this Coverage Part, we will mail or deliver to the first Named Insured shown in the Declarations written notice of the nonrenewal not less than 30 days before the expi- ration date. If notice is mailed, proof of mailing will be sufficient proof of notice. SECTION V — DEFINITIONS 1. "Advertisement" means a notice that is broadcast or published to the general public or specific mar- ket segments about your goods, products or ser- vices for the purpose of attracting customers or supporters. For the purposes of this definition: a. Notices that are published include material placed on the Internet or on similar electronic means of communication; and b. Regarding web - sites, only that part of a web - site that is about your goods, products or ser- vices for the purposes of attracting customers or supporters is considered an advertisement. 2. "Auto" means: a. A land motor vehicle, trailer or semitrailer de- signed for travel on public roads, including any attached machinery or equipment; or b. Any other land vehicle that is subject to a com- pulsory or financial responsibility law or other motor vehicle insurance law in the state where it is licensed or principally garaged. However, "auto" does not include "mobile equip- ment". Page 12 of 16 CG 00 01 12 07 A,UK)iRbr CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) TYPE OF INSURANCE 07/05/2013 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 endorsements s . PRODUCER Advanced Risk Solutions CONTACT NAME: PHONE A/C, No Ext : FAX A/C No 12980 Metcalf Suite 490 Overland Park KS, 66213 E- MAILADDRESS: LIABILITY INSURERS AFFORDING COVERAGE NAIC# INSURER A: Lumbermen's Underwriting Alliance 23108 w advancedrisksolutiors.com INSURED Employers Resource Management Co. For: Pacific Medical Clinic INSURER B: INSURER c: COMMERCIAL GENERAL LIABILITY CLAIMS MADE ❑OCCUR INSURER D: 1534 E Warner Ave Ste A Santa Ana, CA 92705 INSURER E: INSURER F: $ XXXXXX COVERAGES CERTIFICATE NUMBER: REVISION NUMBER' THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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. IN R LTR TYPE OF INSURANCE ADD'L INSRD SIT WVO POLICY NUMBER POLICY EFF MM/DD POLICY EXP MMIDDM^rV LIMITS GENERAL LIABILITY Not Applicable EACH OCCURRENCE $ XX)O(XX COMMERCIAL GENERAL LIABILITY CLAIMS MADE ❑OCCUR DAMAGE TO RENTED PREMISES Ea occurrence ) $ XXXXXX MED EXP(Anyone person) $ XXXXXX PERSONAL &ADV INJURY $ XXXXXX GENERALAGGREGATE $ XXXXXX GEKL AGGREGATE LIMIT APPLIES PER POLICY PRO- ECT LOC PRODUCTS - COMP /OPAGG $ XXXXXX XX $ XXXX AUTOMOBILE LIABILITY A AUTO ALLL L OWNED SCHEDULED Not Applicable k S N COMBINED SIN ELIMI Ea accident $ XXXXXX BODILY INJURY (Per person) $ XXX XXX BODILY INJURY (Per acclderr $ X)(XXXX AUTOS AUT05 HIRED AUTOS NON -OWNED AUTOS .p \� CCU"' "�`�� a o'Coo PROPERTY DAMAGE Peraccident $ XX)(XXX $ once 00 $ UMBRELLA LIAB OCCUR Not Applicalb NOV EACH OCURRENCE $ XXXXXX AGGREGATE $ )()()(X')(X EXCESS LIAB CLAIMS MADE 1'� DED RETENTION $ $ XXXXXX $ XXXXXX $ XXXXXX A WO COMPE S T N AND EMPLOYERS' LIABILITTY ANY PROPRIETOWPARTNER/EXECUTIVIE 429069 07/01/2013 07/01/2014 OTH- X WCSTA ITS ER E.L. EACH ACCIDENT $ 1,000.000.00 OFFICERIMEMBER EXCLUDED? YIN NIA (Mandatory in NH) ❑ If yes, describe under E.L. DISEASEEA EMPLOYEE $ 11000,000.00 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Addltlonal Remarks, Schedule, if more space is required) THIS CERTIFICATE CONFERS NO ADDITIONAL INSURED RIGHTS UPON THE CERTIFICATE HOLDER. Only the co- employees of Pacific Medical Clinic, 1534 E Warner Ave Ste A, Santa Ana, CA 92705 but not subcontractors of: Pacific Medical Clinic CERTIFICATE HOLDER 040695 CANCELLATION City of Santa Ana 20 Civic Center Plaza Santa Ana CA, 92701 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 Robert Gagne !t� T ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD COOPERATIVE OF AMERICAN PHYSICIANS CERTIFICATE OF COVERAGE Coverage through December 31, 2013 Member: Gary A. Linnemann, MD Address: 1534 E Warner Ave Ste A Santa Ana, CA 92705 -5420 This certificate confirms that, on the date below, the above -named physician is a member of the Cooperative of American Physicians, Inc. (CAP) and a participant in the Mutual Protection Trust (MPT). MPT is an unincorporated interindemnity arrangement organized under California Insurance Code section 1280.7. This certificate confers no rights upon the member and does not amend, extend or alter the coverage afforded under the terms, conditions and exclusions of the MPT Agreement. Membership Number I Medical Specialty Coverage Date Retroactive Coverage Date 13895 Occupational Medicine April 1, 2004 June 1, 1993 subspecialty Family Medicine, With Minor Surgery Coverage (Claims made and paid) Current Limits of Liability Medical $1,000,000 for all Claims based upon an Occurrence $3,000,000 each calendar year aggregate 305cv° - Attorney Assistant City The member must remain a Member in good standing or arrange for Tail Coverage for any open or potential Claim that may arise during the Coverage Period. Neither CAP nor MPT undertake any obligation to advise any party, other than the named member, of any changes to or termination of this coverage, Cooperative of American Physicians, Inc. Hammon P. Aeons Vice President, Membership Services Mutual Protection Trust Date August 07, 2013