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<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 />
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