Laserfiche WebLink
AGENCY CUSTOMER ID: CONCGRO-01 <br />LOC #: <br />ADDITIONAL REMARKS SCHEDULE Page 1 of <br />AGENCY <br />NAMED INSURED <br />The Graham Company <br />Occupational Health Centers of California, A <br />POLICY NUMBER <br />Medical Corporation, Go Select Medical Corporatio <br />4716 Old Gettysburg Road <br />Mechanicsburg PA 17055 <br />CARRIER <br />NAIL CODE <br />EFFECTIVE DATE: <br />REMARKS <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE <br />PHYSICIAN PROFESSIONAL LIABILITY COVERAGE - Continental Casualty Company -Policy #HAZ 4032244600-3; Effective 611/2018-2019 - <br />Each Medical Incident/$600,000 Aggregate Per Insured or Surgeon <br />1A PHYSICIAN PROFESSIONAL LIABILITY COVERAGE - Columbia Casualty Company - Policy #HAZ 4032244614-3; Effective 61112018-2019 - <br />Each Medical Incident/$300,000 Aggregate Per Insured or Surgeon <br />CA PHYSICIAN PROFESSIONAL LIABILITY COVERAGE - Columbia Casualty Company - Policy #HAZ 4032244628-3; Effective 6/1/2018-2019 - <br />Each Medical Incident/$600,000 Aggregate Per Insured or Surgeon <br />VANIA PHYSICIAN PROFESSIONAL LIABILITY COVERAGE - Columbia Casualty Company - Policy #HAZ 4032244631-3; 6/1/2018-2019 - <br />Each Medical Incident/$1,500,000 Aggregate Per Insured or Surgeon <br />LIABILITY COVERAGE - Continental Casualty Company - Policy #HAZ 4032244659-3; 6/1/2018-2019 - $1,000,000 <br />Per Insured or Surgeon <br />'COVERAGE: Risk of Physical Loss or Damage to Covered Property subject to policy terms and conditions. <br />COMPENSATION - Occupational Health Centers of California, A Medical Corporation - Policy #WA7-63D-510199-048; Effective: 61112018-2019 <br />Occupational Health Centers of Southwest, P.A. - Policy#WA7-63D-510199-058 and WC7-631-510199-068; Effective: <br />ADDITIONAL WORKERS COMPENSATION POLICIES: <br />of Arkansas — Policy #WC7-631-510199-078; Effective: 6/l /2018-2019 <br />of Southwest (AZ/UT) — Policy 9WC2-631-510199-118; Effective: 6/1/2018-2019 <br />of Delaware — Policy #WC2-631-510199-108; Effective: 61112018-2019 <br />of Georgia/Hawaii — Policy #WC2£31-510199-178; Effective: 611/2018-2019 <br />of Illinois — Policy #WC2-631.510199-198; Effective: 6/1 /2018-2019 <br />of Louisiana — Policy #WC2-631-510199-098; Effective: 6/l/2018-2019 <br />of Michigan — Policy #WC2-631-510199-188; Effective: 6/112018-2019 <br />of Nebraska — Policy #WC2-631-510199-148; Effective: 6/112018-2019 <br />of New Jersey — Policy #WC2-631-510199-138; Effective: 6/1/2018-2019 <br />of North Carolina — Policy #WC7-631-510199-088; Effective: 6/112018-2019 <br />of Southwest (KS) — Policy #WC2-631-510199-128; Effective: 6/1/2018-2019 <br />spy Centers of Southwest I, PA (OR) - Policy #WC2-631-510199-168; Effective: 611/2018-2019 <br />py Centers of South Carolina, PA - Policy #WC2-631-510199-158; Effective: 6/1/2018-2019 <br />LIABILITY- National Union Fire Insurance Company of Pittsburgh, PA - Policy #01-951-89-45; Effective 9125/2017-2018 - Limit: $10,000,000 Security <br />- Endurance American Insurance Company - Policy #PRX10009889401; Effective: 912512017-2018 - Limit: $10,000,000 Each <br />is provided for all medical professionals employed or contracted by the above Named Insured, only while working for or on behalf of the above Named <br />RE: OHC CA/CMC IS BIDDING ON AN RFP #1 B-073 TO PROVIDE MEDICAL SERVICES TO NAMED CLIENT. <br />CITY OF SANTA ANA, ITS OFFICERS, AGENTS, VOLUNTEERS, AND EMPLOYEES IS AN ADDITIONAL INSURED ON THE GENERAL LIABILITY, <br />AUTOMOBILE LIABILITY AND UMBRELLA LIABILITY COVERAGES IF REQUIRED BY WRITTEN CONTRACT. <br />© 2008 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />