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Page 1 of 2 <br />AC a® CERTIFICATE OF LIABILITY INSURANCE <br />ATE <br />D10/24/2017Y) <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($), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, <br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed, <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does notoonfer rights to the certificate holder In lieu of such ondorsament a , <br />PRODUCER <br />A <br />Willie of Seattle, Inc. <br />c/o 26 Century Blvd <br />ONE 1-077-945-7398 X 1-980-467-2379 <br />'MARoXcarti£iaatea8willia. oo�el. <br />$.$L_ <br />P,O, Eox 305191 <br />INSURER(B)AFFORDINGG COVERAGE _NAIC9 <br />Naahvillo, TN 3 7 2 3 05191 USA <br />_ <br />INSURER A I Coverya specialty insurance Company 15606 <br />INSURED <br />Care AAbulanoe aervi0ea, Inc. <br />1517 west Braden Coart <br />INSURER 1 Oreanwich Insurance Company 22322 <br />INSURER C; 9teadfa3t Insurance Company 26397 <br />_ <br />INSURER U: XL Specialty Insurance Company 37885 <br />Orunge, CA 92868 <br />INSURER E: <br />INSURER F, <br />COVERAGES CERTIFICATE NUMBER: W4092490 .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 BEEN REDUCED BY PAID CLAIMS, <br />INS <br />11 <br />TYPE OF INSURANCE <br />AULL <br />B <br />POLICY NUI a <br />POLICY EFF <br />flD <br />DLG E%1+ <br />0 <br />LIMITS <br />X COMMERCIAL GENER�AL LIUIOILITY <br />CLAIMS-MACF. u OCCUR <br />EACH OCCURRENCE $ 11000,000 <br />ES (Ea O.oEB 1,000,000 <br />REMISE' seam aence S <br />MED EXP An ono Preen $ 5,000 <br />A <br />X Broduats-Claime Made <br />y <br />E-10013 <br />10/01/2011 <br />1D/O1/2018 <br />PERSONAL B ADV INJURY $ 1,000,000 <br />GEN'L AGGREGATE UMIT APPLIES PER: <br />GENERALAGGREGATE $ 2,000,000 <br />E]0t POLICY 5g 0 Lao <br />PRODUCTS -COMPIOP AGO $ 2,000,000 <br />$ <br />DHE: <br />AUTOMOBILELIABILITYIts1B <br />NED3INGLE LIMIT $ 1,000,000 <br />BODILY INJURY (Per person) $ <br />�( ANYAVTO <br />E <br />A UTO AUT06ULEO <br />y <br />RAp500047302 <br />10/01/2017 <br />1/01/2018 <br />BODILY INJURY (Per accident) $ <br />HIRED NONANNED <br />AUTOS ONLY AUTOSONLY <br />PftOPERi DAMAGE $ <br />Per cid I <br />_ <br />$ <br />0UNIORELLALIAe <br />>< <br />EXCESS LIAO <br />X <br />OCCUR <br />CLAIMS4,1ADE <br />y <br />UMS414770-04 <br />10/01/2017 <br />10/01/2018 <br />EACHOCCURRENCE $ 15,000,000 <br />AGGREGATE $ 15,000,000 <br />OED I I RETENTION $ <br />$ <br />D <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANYPROPRIETORA'ARTN59RECUTIVE Y N <br />OFF)CERIMEMBEREXOWDED7 No <br />(Mandelory In NR) <br />NIA <br />RWO30009ZB-02 <br />10/01/2017 <br />10/01/2018 <br />X I TA UTE E <br />E.L. EACH ACOIOENT 5 1, 000, 000 <br />E.L. DISEASE• FA EMPLOYE $ 1,000,000 <br />ff YYee deacdbo under <br />DES6RIPTION OF OPERATIONS below <br />E.L. DISEASE• POLICY LIMIT 5 1,000,000 <br />A <br />Mian Medical Profedaional <br />5-10013 <br />10/01/2017 <br />10/01/2018 <br />Par Claim $1,0001000 <br />Liability <br />Aggregate S2, 000, 000 <br />Claims Made <br />Abuee 6 NOIaoLa Lion $1,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ADORE 101, AUditlanal Remarks Schodula, maybe attachad it more apace Is required) <br />Umbrella/Excea$ pollow, Vorm. <br />The City of Santa Ana and their rospootiva officers, officials, employees, representative and volunteers are included <br />as Additional Insured$ per ContraoL or Agreementa with the City of Santa Ana in accordance with the policy provisions <br />of the General Liability, Automobile Liability, and Umbrella/Exoeas Liability policies, <br />w •'- / "' SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />7HE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />The City o£ Santa Ma '/ A!p 0AUTHORIZEDREPRESENTAINE <br />20 Civic Center Plaza �/ 1111 (!„ e. n <br />01989.2515 ACORO CORPORATION. All rlchts reserved <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />OR So, 15222435 eh=a 459671 <br />