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OCCUM-1 OF ID: AM
<br />14l R® CERTIFICATE OF LIABILITY INSURANCE
<br />D0812112018Y)
<br />0812112018
<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(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />Anthonytoetta Ins Agency
<br />410 West Fallbrook Avenue#202PHC
<br />Fresno, CA 93711
<br />Tony Stornetta
<br />CONTACT
<br />NAME: TONY STORNETTA
<br />No E.t,559.492-1361 A/C N,; 559-354-0190
<br />e.
<br />noo TONY STORINS.COM
<br />INSURER(S) AFFORDING COVERAGE NAIL H
<br />TCOMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE ® OCCUR
<br />INSURER A: Hanover 31534
<br />INSURED OCCU-MED, LTD
<br />2121 W BULLARD AVE
<br />FRESNO, CA 93711
<br />INSURERB:CNA 35289
<br />INSURERC:
<br />EACH OCCURRENCE $ 2,000,000
<br />R TED
<br />PREMISES Ea occurrence) $ 300,000
<br />INSURER D:
<br />INSURER E
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER: 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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/ODIVYYY
<br />POLICY EXP
<br />MMIDDIYYVY
<br />LIMITS
<br />A
<br />TCOMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE ® OCCUR
<br />OHF9262847
<br />08/13/2018
<br />08/13/2019
<br />EACH OCCURRENCE $ 2,000,000
<br />R TED
<br />PREMISES Ea occurrence) $ 300,000
<br />MED EXP (Any one person) $ 5,000
<br />PERSONAL &ADV INJURY $
<br />ELUL AGGREGATE LIMIT APPLIES PER
<br />POLICY ā¯‘JECOT LOC
<br />GENERAL AGGREGATE $ 4,000,000
<br />PRODUCTS - COMP/OP AGG $ 4,000,000
<br />IEMPL BENE $ 1,000,000
<br />OTHER
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT $ 1,000,000
<br />Ea accident
<br />AIANY
<br />AUTO
<br />D258905
<br />D258905
<br />05/15/2018
<br />05/1512019
<br />BODILY INJURY (Per person) $
<br />ALL AUTOS OWNED X SCE
<br />BODILY INJURY (Per accident) $
<br />NON -OWNED
<br />HIRED AUTOS
<br />NonTOwned
<br />Hired Car X
<br />PROPERTY DAMAGE $
<br />Per accident
<br />$
<br />X
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE $ 4,000,000
<br />AGGREGATE $ 4,000,000
<br />A
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />OHF9262847
<br />08/13/2018
<br />08/13/2019
<br />DED RETENTION$
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY OFFICER/MEMBEREXCLNERIE ECUTIVE YIN
<br />NIA
<br />D258679
<br />06/06/2018
<br />06/0612019
<br />X STATUTE EOR
<br />E.L. EACH ACCIDENT S 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000
<br />(Mandatory In NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E, L. DISEASE -POLICY LIMIT $ 1,000,000
<br />A
<br />EMPL PRACTICES LIA
<br />OHF9262847
<br />08/13/2018
<br />08/13/2019
<br />AGGREGATE 250,000
<br />B
<br />PROFESSIONAL LIAB
<br />425437058
<br />08/22/2018
<br />08/22/2019
<br />AGGREGATE 5,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
<br />Notice of cancellation is 30 days except in the event of cancellation for
<br />non-payment or non -reporting which Is 10 days. The City of Santa Ana its,
<br />officers, agents, volunteers, and employees are added as additional insured
<br />as respects to operations and activities of, or on behalf of the named
<br />insured performed under contract with the The City of Santa Ana, ...
<br />CERTIFICATE HOLDER CANCFI I ATION
<br />SANTAAN
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />CITY OF SANTA ANA
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 CIVIC CENTER PLAZA
<br />SANTA ANA, CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />Tony Stornetta
<br />© 1988.2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />
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