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Tori Pierson Digitally signed byT°"P'en°^
<br />Date: 201 10:21,16 -07'00'
<br />HEALMAN-01 KBUCHER
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DATE 1
<br />a12612zsnozl
<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(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 endorsements .
<br />PRODUCER
<br />Thompson Flanagan Executive Liability Group
<br />626 W. Jackson �lvd. 5th Floor
<br />Chicago, IL 60661
<br />D MMTACT Timothy M. Ingersoll
<br />E:
<br />PHONE FAX
<br />IAICp, Set: (312) 239-2812 A/C, No):(312) 263-1551
<br />�No,
<br />ADDRESS: tingersol@thompsonflanagan.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC#
<br />INSURER A: Travelers Indemnity Company of America
<br />25666
<br />INSURED
<br />Health Management Associates, Inc.
<br />120 N. Washington Square, #705
<br />Lansing, MI 48933
<br />INSURER B:Travelers Property Casualty Co. of America
<br />25674
<br />INSURER C,AIIied World Insurance Company
<br />22730
<br />INSURER D :
<br />INSURER E:
<br />INSURER F :
<br />COVERAGES CERTIFICATE_ NIIMRFRe RFVIRIf1N NHMRPR-
<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 />LTRTYPE
<br />OF INSURANCE
<br />ADDL
<br />p
<br />SUBR
<br />p
<br />POLICY NUMBER
<br />POLICY EFF
<br />0
<br />POLICY EXP
<br />0oDYYYI
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE X OCCUR
<br />X
<br />X
<br />630-BP53244A
<br />4/15/2021
<br />411512022
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO RENTED
<br />PREMISES Eaoc u e
<br />300000
<br />J(
<br />MED EXP LAny onePersian)
<br />$ 5,000
<br />Owner's & Contractor
<br />XCU included
<br />PERSONAL B ADV INJURY
<br />$ 1,000,000
<br />X
<br />AGGREGATE LIM IT APPLIES PER:
<br />POLICY j [X] LOC
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GENT
<br />PRODUCTS-COMP/OPAGG
<br />Z,000,OOO
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />$ 1,000,000
<br />BODILY INJURY Per person)
<br />X
<br />BA-SP532647
<br />4115/2021
<br />4115/2022
<br />_
<br />OANY WNED
<br />OWNED SCHEDULED
<br />AUTOS ONLY A�U�TNNOppBVw�rr
<br />INJURY Per accident)
<br />$
<br />pBODILY
<br />IPe�P.ER tl AMAGE
<br />_
<br />$
<br />X.-
<br />AUTOS ONLY X AUTOV6Na
<br />B
<br />X
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />EACHOCCURRENCE
<br />$ 10,000,000
<br />AGGREGATE
<br />$ 10,000,000
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />CUP-BP533005
<br />4115/2021
<br />411512022
<br />DED RETENTION$
<br />B
<br />WORKERS COMPENSATION
<br />EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNERIEXECUTIVE YIN
<br />FFICERIMEMBWp EXCLUDED? �N
<br />Mandatory in NH)
<br />II ee,describounder
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />UB-8P532740
<br />4115/2021
<br />411512022
<br />1( PARTITE
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />11000,000
<br />E.L.DISEASE - EA EMPLOYE
<br />_
<br />$ 1+000,000
<br />E.L. DISEASE -POLICY LIMIT
<br />1,000,000
<br />C
<br />Prof. Liability
<br />0312-1907
<br />1113l2021
<br />117312022
<br />Per Claim/Aggregate
<br />5,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />Excess Cyber: Policy Number - CYX E661010-Ob - Limit: $5,000,000-1113/21-1113122 - Great American Insurance Company
<br />The City of Santa Ana, its officers, officials, employees, and volunteers are to be covered as additional insureds on the CGL policy with respect to liability.
<br />arising out of work or operations performed by or on behalf of the Contractor including materials, parts, or equipment furnished in connection with such work
<br />or operations. For any claims related to this contract, the Contractor's insurance coverage shall be primary coverage at least as broad as ISO CG 20 01 0413
<br />as respects the Entity, Its officers, officials, employees, and volunteers. Any Insurance or self-insurance maintained by the Entity, its officers, officials,
<br />employees, or volunteers shall be excess of the Contractor's insurance and shall not contribute with it. The Consultant hereby grant to Grantee a waiver of
<br />SEE ATTACHED ACORD 101
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza
<br />ACORD 25 (2016103)
<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
<br />e„aw.w. RtaklNregeminit0lWWn
<br />AUTHORIZED REPRESENTATIVE ��,'-��i�4 RENLVIED6ApplifiVa)BY:
<br />Gas f�y�jm P J+\Rdt■iIp�JI(F+IdI� 7aa� 7 ew as
<br />A —"- Risk Managenxne ClttieNAide
<br />@ 1988.2015 ACORD C(
<br />The ACORD name and logo are registered marks of ACORD
<br />
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