Laserfiche WebLink
THE HEALTHCARE INSURANCE CORPORATION <br />Box 1051GT • Barclay's House - 3rd Floor • Shedden Road • Georgetown, Grand Cayman • Cayman Islands, B.W.I. <br />CERTIFICATE OF INSURANCE CLAIMS MADE POLICY <br />#03-05 47V <br />DATE ISSUED: May 19, 2003 <br />ISSUED TO: City of Santa Ana <br />Clerk of the City Council <br />20 Civic Center Plaza (M-30) <br />ADDRESS: Santa Ana, CA 92702 <br />RE: Service Provider Agreement 1/15/01-11/30/01 <br />THIS IS TO CERTIFY that insurance has been effected with THE HEALTHCARE INSURANCE <br />CORPORATION (the "Company",) under Policy Number 2003-05 as follows: <br />INSURED: Tenet Healthcare Corporation and/or Western Medical Center - Santa Ana <br />ADDRESS: 3820 State Street 1001 N. Tustin Ave. <br />Santa Barbara, California 93105 Santa Ana, CA 92705 <br />ADDITIONAL INSURED: City of Santa Ana, its agents, employees and elected and appointed officials are <br />Additional Insureds but only with respect to captioned agreement. This insurance is primary and not <br />contributing. <br />COVERAGE: Comprehensive General Liability, Medical Professional Liability, Contractual Liability, Personal <br />Injury Liability, Druggist's Liability, Managed Care Organizations' Errors and Omissions Liability, Employment <br />Practices Liability, and Miscellaneous Professional Liability WRITTEN ON A CLAIMS -MADE BASIS. <br />AMOUNT OF INSURANCE: Not less than $25,000,000 per claim. <br />Not less than $25,000,000 per claim (General Liability). <br />SELF-INSURED RETENTION: $2,000,000 <br />POLICY TERM: June 1, 2003 at 12:01 A.M. to June 1, 2004 at 12:01 A.M. LOCAL TIME at the address of the <br />Insured. <br />THIS CERTIFICATE is not transferable and may be cancelled by giving thirty days written notice to the party to <br />which this Certificate is issued prior to the effective date of the cancellation of the insurance described herein. <br />THIS CERTIFICATE is for information only; it is not a contract of insurance, but attests that a policy as <br />numbered herein, and as it stands at the date of this Certificate, has been issued by the Company. Said policy <br />is subject to change by endorsement and cancellation in accordance with its terms. <br />EFFECTIVE DATE OF THIS CERTIFICATE: June 1, 2003 <br />CERTIFICATES EXPIRES: June 1, 2004, unless cancelled sooner. <br />cc: Tenet Healthcare Corporation A 'HKOVED AS TO FORN4 <br />Risk Management Department <br />13737 Noel Rd., Suite 100 <br />Dallas, Texas 75240 - __ -___ _.. <br />Tel: 877-893-8363 <br />.„ r, �ncricv <br />Signed by 04A4 t41 Qm-&- <br />Assistant Secretary <br />