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ACORD,. CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDNVYY} 9/1/2005 PRODUCER 50 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Arthur J. Gallagher & Co. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE License #0726293 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 505 North Brand Blvd, Suite 600 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Glendale, CA 91203-3944 Phone: 818-539-2300 Fax: 818-539-2301 INSURERS AFFORDING COVERAGE NAIC# "_.~-- IINSURERA: INSURED Hartford Casualty Insurance Company 29424 U.S. HealthWorks, Inc. INSURER B: Hartford Fire Insurance Company 19682 3655 North Point Parkway, Suite 150 Hartfo~d Insurance Company of the Midwest 37478,._ Alpharetta, GA 30005 INSURER c: A - ;).003- ;;1.;;2.'1-0 "'- INSURER 0: , INSURER E" COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. [mS'R ADD'LI - POLlCYEFFEC1WE POLICY EXPIRATION I I TD i':'..o...1 POLlCY NUMBER .......... ~ENERA;L LIABILITY 72UENUM8309 'X COMMERCIAL GENERAL LIABILITY 1 r::-lX ~~ CLAIMSMADE l.".1 OCCUR - LIMITS 1,000,000 300.000 09/01/05 09/01/06 $ $ EACH OCCURRENCE ~~~~~~~?E~~~~~r~()ce\ A 10,000 MED EXP (Anyone person) 1,000,000 3,000,000 3,000,000 PERSONAL 8. ADV INJURY GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ COMBINED SINGLE LIMIT $ (Eaaccidenl) BOD\L Y INJURY $ (Per person) BODILY INJURY $ (Per accident) PROPERTY' DAMAGE $ (Peraccidenl) AUTO ONLY _EAACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EACH OCCURRENCE $ AGGREGATE $ $ $ $ ~'LAGGRE~E LIMIT AP~S PER: I I POLICY I I ~!39; I X I LaC ~TOMOBILE LIABILITY ~ ANY AUTO ~ ALL OWNED AUTOS ~ SCHEDULED AUTOS ~ HIRED AUTOS ~ NON-OWNED AUTOS - 09/01/06 72UENUM8309 09/01/05 B 1,000,000 GARAGE LIABILITY ~ ANY AUTO '~ESSIUMBRELLA LIABILITY ~ OCCUR D CLAIMS MADE =:} DEDUCTIBLE x-j ~ETENTION $ 10 000 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORlPARTNERlEXECUTlVE IOFFICERlMEMBEREXCLUDED? ~P~~~~~~~VIS~ONS below OTHER 10,000,000 10,000,000 09/01/06 09/01/05 72XHUTQ5969 A XiWCSTATU- I 10TH- I TORY L1MIT.c; I FR E.L. EACH ACCIDENT $ 1,000,000 ~L._~I~EA_S~_~_~~?LOY~ ~_ ____1 ,O~O,O~~ I EL DISEASE _ POLICY LIMIT I $ 1,000,000 72WNMG3070 09/01/05 09/01/06 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS *Except 10 days notice for non-payment of premium. RE: 1530 EAST EDINGER, SANTA ANA, CA 92705 /h~~:/ ~/ {r.Le' (1'1 1./ :::::. .' CANCELLATION CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ~C-~~ '---- @ACORDCORPORATION1988 City of Santa Ana 20 Civic Center Plaza Santa Ana, CA 92701 ACORD 25 (2001/08)