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RC390118
<br />AC40R,br CERTIFICATE OF LIABILITY INSURANCE
<br />DAT612712023YY)
<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 endorsement(s).
<br />PRODUCER
<br />NAME CONCT
<br />Safehold Special Risk, Inc. (916) 589-8000
<br />PHONE FAX
<br />In Callfornla,Safehold Special Risk & Insurance Services,lnc. #OG13561
<br />UA& No Exti AIC No:
<br />10940 White Rock Road, 2nd Floor
<br />ADDRESS:
<br />INSURERS) AFFORDING COVERAGE
<br />NAIC#
<br />Rancho Cordova, CA 95670-6076
<br />INSURERA: Everest National Insurance Company
<br />10120
<br />INSURED
<br />INSURER B:
<br />Orange County Emergency Pat Clinic, Inc
<br />INSURER C:
<br />12750 Garden Grove Blvd.
<br />INSURER D:
<br />INSURER E:
<br />Garden Grove CA 92643
<br />INSURER F:
<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 />LTR
<br />TYPE OF INSURANCE
<br />ADDLSUM!
<br />INSD
<br />WID
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMICDIYYYY
<br />POLICY EXP
<br />MMIDDIYYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE I X I OCCUR
<br />X
<br />—SH00000688-231
<br />07/01/2023
<br />07/01/2024
<br />EACH pCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO ftE D
<br />PREMISES Eaoccurrence
<br />$ 1,000,000
<br />MED EXP (Any one person)
<br />$ 10,000
<br />PERSONAL It ADV INJURY
<br />!$ 1,000,000
<br />AGGREGATE LIMITAPPLIES PER
<br />PRO -
<br />POLICY E JECT LOC
<br />GENERAL AGGREGATE
<br />,$ 2,000,000
<br />GEN'L
<br />PRODUCTS-COMPIOPAGG$
<br />2,000,000
<br />S
<br />Gl"HER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />SH00000685-231
<br />07/01/2023
<br />07/01/2024
<br />COMBINED SINGLE LIMIT
<br />I$ 1,000,000
<br />%
<br />ANYAUTO
<br />BODILY INJURY (Par person)
<br />$
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Peracc,14
<br />$
<br />A
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />SH00000689-231
<br />07/01/2023
<br />07/01/2024
<br />EACH OCCURRENCE
<br />$ 3,000.000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />AGGREGATE
<br />$ 3,000,000
<br />DED I X I RETENTION$ 10,000
<br />$
<br />A
<br />TION
<br />AND EMPLKERSOYERS'
<br />AND EMPLOYERS' LIABILITY
<br />YERS'LIAILIT YIN
<br />ANYPROPRIETORIPARTNERIEXECUTIVE
<br />OFFICEWMEMaEREXCLUDED? ❑
<br />N/A
<br />SH00000686-231
<br />07/01/2023
<br />07/01/2024
<br />X STATUTE EERH
<br />E.L. EACH ACCIDENT
<br />I$ 1,000,000
<br />E.L. DISEASE - EA EMPLOVEEI$
<br />1,000,000
<br />(Mandatory In NH)
<br />tryes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT$
<br />1,000,000
<br />A
<br />Professional Liability
<br />SHPLOO1565-231
<br />07/01l2023
<br />07/01/2024
<br />$1,000,DDD Ea oh Occurrence
<br />-
<br />$3,000,000 Aggregate
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 10t Additional Remarks Schedule, may be attached if mere space Is required)
<br />ECG 20 590 05 09,WC 04 03 06,CG 00 01 04 13,ECG 04 767 02 16 The City of Santa Ana, its officers, employees, agents, and representatives are
<br />named as Additional Insured with respect to General Liability per the attached endorsement. Primary Wording included and attached. Waiver of
<br />Subrogation for General Liability and Workers Compensation attached.
<br />City Of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />20 Civic Center Plaza (M-30) - _ ACCORDANCE WITH THE POLICY PROVISIONS. -
<br />Santa Ana, CA 92702
<br />AUTHORIZED REPRESENTATIVE
<br />The ACORD name and logo are registered marks of ACORD (D1988.2015 ACORD CORPORATION. All rights reserved.
<br />AGUKL1 LO (LU'I UIU3)
<br />
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