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<br />A"cc>j?br CERTIFICATE OF LIABILITY INSURANCE
<br />111r
<br />D09/25/2018
<br />09/25/2018
<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 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 not confer rights to the certificate holder In lieu of such endorsement(s).
<br />PRODUCER
<br />Willis of Seattle, Inc.
<br />c/o 26 Century Blvd
<br />P.O. Box 305191
<br />CONTACT
<br />NAME:
<br />PHONE 1-877-945-7378 FAX 1-888-467-2378
<br />AIC, No):
<br />EMAIL certificates@willia.com
<br />ADO ESS:
<br />INSURERS AFFORDING COVERAGE NAIC#
<br />Nashville, TN 372305191 USA
<br />INSURERA: Coverys Specialty Insurance Company 15686
<br />INSURED
<br />Cara Ambulance Services, Inc.
<br />INSURER 8: Oreanwich Insurance Company 22322
<br />INSURERC: Steadfast Insurance Company 26387
<br />1517 West Braden Court
<br />INSURER XL Specialty Insurance Company 37885
<br />Orange, CA 92868 USA
<br />INSURER E:
<br />INSURER F :
<br />LiUVCKAL9C5 CIHI IFICATF NIIMRFR•W I 995UJ DC%IICI^Kl NumaDCO.
<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 />INBRR
<br />OF INSURANCE
<br />ADDTYPE
<br />INSID
<br />WVD R
<br />POLICYNUMBER
<br />MMIPOLDOmYY
<br />POLICY EXP
<br />LIMITS
<br />X COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE $ 1,000,000
<br />LAMA NLN I bD
<br />CLAIMS -MAGE OCCUR
<br />PREMISES Ea occurrence $ 1,000,000
<br />A
<br />X Prodvoks-Claims Made
<br />MED EXP (Anyoneperson) $ 5,000
<br />PERSONAL &ADV INJURY $ 1,000,000
<br />y
<br />5-10013
<br />10/01/2018
<br />10/01/2019
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE $ 2,000,000
<br />%0 PRO-
<br />POLICY
<br />PRODUCTS-COMP/OP AGG $ 2,000,000
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT $ 1,000,000
<br />Ea accident
<br />X
<br />ANY AUTO
<br />BODILY INJURY (Per person) $
<br />H
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />y
<br />RAD500047603
<br />10/01/2018
<br />10/01/2019
<br />BODILY INJURY(Peracddenl) $
<br />HIRED NON -OWNED
<br />PROPERTY DAMAGE $
<br />AUTOS ONLY AUTOS ONLY
<br />Per arcidont
<br />C
<br />UMBRELLALIAS
<br />X
<br />OCCUR
<br />EACH OCCURRENCE $ 15,000,000
<br />X
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />I
<br />UMB5414710-05
<br />10/01/2018
<br />10/01/2019
<br />AGGREGATE $ 15,000,000
<br />DED I RETENTION
<br />$
<br />WORKERS COMPENSATION
<br />X PER OH_
<br />STATUTE ER
<br />EMPLOYERS' LIABILITY YIN
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />D
<br />ANYPROPRIETOR/PARTNERIEXECUTIVE
<br />No
<br />OFFICER/MEMBEREXCLUOE07 �
<br />NIA
<br />RM300095503
<br />10/01/2018
<br />10/01/2019
<br />El DISEASE -EA EMPLOYEE $ 1,000,000
<br />(Mandatory In NH)
<br />f yes, resents under
<br />E, L. DISEASE -POLICY LIMIT $ 1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />A
<br />Mise Medical Professional
<br />5-10013
<br />10/01/2018
<br />10/01/2019
<br />Per Claim $1,000,000
<br />-
<br />LiabilityClaims Made
<br />Aggregate $2,000,000
<br />Abuse S Molestation $1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
<br />Umbrella/Excess Follows Form.
<br />The City of Santa Ana and their respective officers, officials, employees, representative and volunteers are included
<br />as Additional Insureds per Contract or Agreements with the City of Santa Ana in accordance with the policy provisions
<br />of the General Liability, Automobile Liability, and Umbrella/Excess Liability policies.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ROVEDACCORDANCE WITH THE POLICY PROVISIONS.
<br />The City of Santa Ana �/I �,-(dp�r'< �v, s P AUTHORIZED REPRESENTATIVE
<br />20 Civic Center Plaza/ r'v" r
<br />Santa Ana, CA 92701 /'`�cr� //
<br />© 1988.2016 ACORD CORPORATION. All riahtH reser veal
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />SR Io: 16754036 9ATCH: 880201
<br />
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