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Francine R. Digitally rigned by Francine R. <br />Villareal <br />Villareal Dace: 2022.011609:a4:17 <br />EVIDENCE OF COVERAGE ISSUE DATE (MMIDDIYY) -0800 <br />01/19/2022 <br />SPONSOR <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />Kaiser Foundation Health Plan, Inc. <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />Attention: Corporate Risk Management <br />ALTER THE COVERAGE ARRANGEMENTS SET FORTH BELOW, <br />One Kaiser Plaza, 25'h FI. <br />Oakland, CA 94612 <br />COVERAGE AFFORDED <br />COVERED ENTITIES <br />LETTER A <br />Kaiser Foundation Health Plan, Inc. <br />Self -insured <br />Kaiser Foundation Hospitals <br />COVERAGES <br />CO TYPE OF COVERAGE DESCRIPTION <br />EFFECTIVE DATE EXPIRATION LIMITS <br />LTR <br />MMIDDIYY DATE MMIDDIYY <br />A <br />Hospital/Physician/Professional <br />Self -Insured <br />1/1/2022 <br />1/1/2023 <br />Each Occurrence: $ 5,000,000 <br />Liability <br />Annual Aggregate: None <br />S.Y.r <br />DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS <br />This certificate provides evidence of professional liability coverage for the above -named entities in accordance with a written <br />contract or agreement. <br />Kaiser Mobile Health Vehicle - coming onsite to hold biometric City of Santa Ana <br />screenings & flu shots 20 Civic Center Plaza <br />Santa Ana <br />CA 92701 <br />[RC006161] <br />CERTIFICATE HOLDER <br />CANCELLATION <br />City of Santa Ana <br />NOT APPLICABLE <br />20 Civic Center Plaza, <br />AUTHORIZED REPRESENTATIVE <br />Santa Ana, CA 92701 <br />Mario Espindola <br />Martin King, VP <br />KPCRMEOC 21 (2021 0628) <br />Walt Mnugmwnt Divisimt <br />n CREVIEWED&APPR.C,VtEDBr': <br />® Risk Management Malys[ <br />