DR. SCOTT WELDY, DBA SERRANO ANIMAL AND BIRD HOSPITAL

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_—IMIRIP SERRANI-01 DTHOMAS 11*. 914/2 � 7" CERTIFICATE OF LIABILITY INSURANCE DATE D/YYYY) `� r4rzo19 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. r— IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER C NTACT Dian Thomas Veterinary Insurance Services Company PHONE No, Ext : arc No :(918 921-2266 1400 River Park Drive, #180 Sacramento, CA 95815 IA I dthomas@vise-ine.com INS RE AFFORDING COVERAGE AIC # INSURERA.- Allianz Global/ Fireman's Fund INSURED INSURER B:Preferred Employers Ins 10900 Serrano Animal & Bird Hospital, Inc. INSURER C Scott H. Weldy, DVM 21771 Lake Forest Drive #111 INSURER D ; Lake Forest, CA 92630 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL. SUBR POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE OCCUR �( AZC80928980 7/1/2019 7/1/2020 DAMAGE TO RISES (EaENTED 100,000 IRECn =VD /An — nc. % It 10,000 LAGGREGATELIMITAPPLIESPER: GENERAL AGGREGATE $ 2,000,000 POLICY JELQT LOC PRODUCTS - COMP/OP AGG $ 2,000,000 A AUTOMOBILE LIABILITY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS SSWN AUTOS ONLY X AUOTOS ONLY �AZC80928980 7/1/2019 7/1/2020 COMBINED SINGLE LIMIT $ 1,000,000 BODILY INJURY Perperson) $ IxANY BODILY INNJURY Per accident Parlent AMAC3E 4�BRELLA LIAB ESS LIAB CLAIMS -MADE EACH OCCURRENCE HOCCUR E $ RETENTION $ B WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY ApFFICERIMEMBER EXCLUDED ECUTIVE Y� (Mandatory In NH) If Yes, describe under DESCRIPTION OF OPERATIONS below NIA TN164036-3 - 7/1/2019 7/1/2020 X PER TE 07H- STATU ER EL EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYE $ 1,000,000 E L DISEASE - POLICY LIMIT $ 1,000,600 DESCRIPTION OF DPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) '30 Day's Notice of Cancellation / 10-Days NOC for non-payment. Certificate holder is named as additional insured Per ABC MultiCover AB9189 0807. City of Santa Ana, its officers, agents and employees are included as addtional insureds. REWMED & APPROVED BEHOLDER "r "`' CANCELLATION 7 2019 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ty ACCORDANCE WITH THE POLICY PROVISIONS. Risk Management Divlslo A THA M. LAMBERT 20 Civic Center Plaza, 4th Fum Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD