COMMUNITY HEALTH INITIATIVE OF ORANGE COUNTY (5)

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CERTIFICATE OF LIABILITY INSURANCE 9/11/2017' THIS CERTIFICAT418 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(ies) 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 cortlficats holder In lieu of such ondorsoment s . PRIER PAYCHEX INSURANCE AGENCY INC/PAC 250881 P: F: (888) 443-6112 PO BOX 33015 SAN ANTONIO TX 78265 CONTACT NAME (NONoU,t): t'I (ND,N.p (888) 443-6112 E-MAIL % "— ADDRE99 INSURER(S) AFPORONE COVEra E NAICN INBURERA: Hartford Ins Cc of he Midwest 37478 INSURED COMMUNITY HEALTH INITIATIVE OF ORANGE COUNTY 1505 E 17TH ST STE 121 SANTA ANA CA 92705 WSURERB: INSURER 0: INSURER D: INSURER E: INSURER F: COVERAGES CPtTIFICATE NUMBER: / REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIE OF INSURANCE LISTED BELOW HAVEBEENIS EO TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITI•ISTANDING ANY REQ EMENT, TERM OR CONDITION OF ANY NTRACT OR OTHER DOCUMENT' WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PVI RTAIN, THE INSURANCE AFFORDED Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH P I IES. LIMITS SHOWN MAY HAVE N REDUCED BY PAID CLAIMS, JNSA TYPE OPINSORANCE .9DDL SOAlf I _`flLICYNVMSRA LICY RF'P MIRD/YYYY pOLICYCXP LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑OCCUR - EACH OCCURRENCE $ DAMAGETORENTCD $ PREMISES Ea occurrence) MEDEXPIAny Nnepemor) $ PERSONAL &ADV INJURY $ GE'L AGOHROATE LI MIT APPLIES PER: POLICY PRO ❑ LOC ECT OTHER: OENERALAGGREGATE $ PRODUCTS-COMPIOP AEG $ $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHISELLED AUTOS ONLY AUTOS HIRED NON-CWNEO AUTOS ONLY AUTOS ONLY COMEINEO SINGLE LIMIT (Fe ecUdanq BODILY INJURY (Per person) y BODILY INJURY (Par aecldenq $ PROPERTY DAMAGE IPafauNldeal)H $ K UMBRELLA LIAR EXCESS HAS OCCUR CLAIMS -MAD EA OCCURRENCE $ AGGHEa E y LED IVENTIONI $ A IVORARR9 CDMI'SMGTlON ANPRDfPLDYRNS'LIAtl1Lf5'Y ANY PROPRIETORIPARTNENEXECU'rw YIN OFFICERIMEMaER EXCLUDEDT (Mammals, In NH) ❑ Ier F OFOOPERATI Shelow NIA 76 WEE PK2991 11/01/2016 11/01/2017 X PER ODI- STATUTE OR E.L. EACH ACCIDENT 511 0001 COC E.L. DISEASE FA EMPLOYEE $11 000, 000 E.L. DISEASE -POLICY LIMIT 1-,000,000 DESCRIPTIONOPOPORI I LOCATIONS/VEHICLES (ACORD 101, Additional Remarks 9chNdula, may be ahaehed If morn epaue Is required) �r Those usual to the Insured's Operations. [HX:iiltlfdL�1�:UP�7b: N7\d[9-�i[7r © 1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORO 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. FOR INFORMATIONAL PURPOSE ONLY AUTHORIZED REPRESENTATIVE 1505 E 17TH ST STE 121.— SANTA ANA, CA 92705 © 1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORO name and logo are registered marks of ACORD