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AC R CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) <br /> `,/ 04/30/2024 <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 • CONTACT <br /> NAME: FAX <br /> Hiscox Inc. e!�° �A��BkUy uj C No): <br /> 5 Concourse Park y n g I eDig _ v contcoeAt iscox.com <br /> Suite 2150 ADDRESS: <br /> Atlanta GA,30328 INSURERIS)AFFORDING COVERAGE NAICM <br /> yF�,I`Hiscox Insurance Company Inc 10200 <br /> INSURED A caved <br /> C D Medical l L ACC' t ;0 <br /> 200 14th 74th street <br /> Key Colony Beach,FL 33051 INSUR D���J������� <br /> D a R 1 �I-06 <br /> INSURER F <br /> COVERAGES CERTIFICATE EBT ( <br /> REVISION B HS IS TO ERTIFY T- �-1E POL C EOF N JR/ iC STED BEL A EE I4UE DTO711-11 DRDNAMD ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIR IMF'.r, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAlk 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 EFF POLICY EXP <br /> T TYPE OF INSURANCE INSET SUBR POLICY NUMBER (MMIDDY/YYYY) (MMIDD/YYYYI LIMITS <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 100,000 <br /> MED EXP(My one person) $5,000 <br /> A X Primary&Noncontributory Y Y UDC-2110737-CGL-23 11/17/2023 11/17/2024 PERSONAL BADV INJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> X POLICY PET LOC PRODUCTS-COMP/OP AGG $ S/T Gen.Agg <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> (Ea accident) <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED —I NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY 1 AUTOS ONLY (Per accident) <br /> 1 $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION§ $ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER <br /> ANYPROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ <br /> OFF ICER/MEMBEREXCW DEDP <br /> (Mandatory In NHi E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) <br /> City of Santa Ana,its City Council,officers,employees,agents and volunteers are added as additional insured under the general liability and professional liability.It is endorsed with <br /> a Waiver of Subrogation in favor of the additional insured subject to policy terms and conditions.Insurance shall be primary and non-contributory.Hiscox will endeavor to provide 3 <br /> 0-day notice of cancellation subject to policy terms and conditions. <br /> CERTIFICATE HOLDER CANCELLATION <br /> City of Santa Ana <br /> Attention:Kenneth Willard 20 Civic Center Plaza M-88,Santa Am,CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOr •'' """ "S ----- — fp <br /> ACCORDANCE WITH THE POLICY PR( "•• <br /> ,,wee.\ Risk Management Division I <br /> AUTHORIZED REPRESENTATIVE �I(�/�a/({ , REVIEWED&APPROVED BY: r <br /> y`t/ L�k rrk��e$$$ �f-r cevu(a <br /> !{-(�' Risk Management Specialist <br /> 4! . <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />