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CHESMED-01 <br />SPERFZ <br />DAM(MMfDD° u" <br />ik� CERTIFICATE OF LIABILITY INSURANCE <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 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 not confer rights to the certificate holder In lieu of such endorsemen! s . <br />PRODUCER <br />CAP Physicians Insurance <br />333 S Hope 8th FI <br />Los Angeles, CA 90071 <br />Los <br />NA °i Diana Leo <br />FAX <br />lac°,No,E.t):(213) 473-8653 (A/CC,No:(213)473$619 <br />AADD I . dleonclo@Ca h sicians.com <br />INSURERISI AFFORDING COVERAGE NAC d <br />INSURER A; Hanover <br />INSURED <br />INSURER 8, <br />INSURER C: <br />Cheshire Medical Corporation dba ProCero Work Injury <br />Center <br />17232 Red HIII Ave. <br />INSURER D: <br />INSURER E <br />Irvine, CA 92614 <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />TYPE OF INSURANCE <br />INSD <br />SUBR INVID <br />POLICY NUMBER <br />POLICY EFF <br />PODGY EXP <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />CLAM&MADE OCCUR <br />EACH OCCURRENCE <br />$ <br />DAMAGE TO RENTED <br />PREMISES <br />MED EXP (Any one rsen <br />PERSONALAADV INJURY <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY El jPCOT LOC <br />OTHER: <br />GENERAL AGGREGATE <br />PRODUCTS-CCMP/OP AGG <br />$ <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOpSW <br />AUTOS ONLY AUTOS ONE <br />EOMBINED SINGLE LIMIT <br />, accident) <br />$ <br />BODILY INJURY Per rem <br />$ <br />BODILY INJURY Per aafdent <br />PROPERTY DAMAGE <br />Per accitlent <br />UMBRELLA LIAR <br />EXCESS LIAS <br />OCCUR <br />CLAIMS -MADE <br />EACH OCCURRENCE <br />AGGREGATE <br />If <br />DELI I I RETENTIONS <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />YIN <br />ANYPROPRIETOR/PARTNERIEXECUTIVE <br />(Mandatory in NH) EXCLUDED? <br />U Yes, describe antler <br />DESCRIPTION OF OPERATIONS EeIgw <br />NIA <br />3A938083 <br />61112019 <br />✓ <br />61112020 <br />PER FERN - <br />X I <br />E.L. EACH ACCIDENT <br />1,000,000 <br />E.L. DIBEAGE - EA EMPLOYE <br />1,000.00 <br />E.L. DISEASE -POLICY LIMIT <br />1,000,000 <br />E <br />DESCRIPTION OF OPERATIONS LOCATIONS VEHICLES (ACORD 101, Addition Ro EWEhe e& EIf space Is required) <br />By Risk MANAGEMENT DIVISION <br />AP�/bj ,91020 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />A�UTTHHOR(MEED�(REEPRESENTATIVE <br />ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />