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<br />, <br />ACORD~ CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDNYVY) <br />813112005 <br />PRODUCER 50 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />Arthur J. Gallagher & Co. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />License #0726293 HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />505 North Brand Blvd, Suite 600 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Glendale, CA 91203-3944 <br />Phone: 818~539-2300 Fax: 818.539-2301 INSURERS AFFORDING COVERAGE NAIC# <br />INSURED INSURER A: Hartford Casualty Insurance Company 29424 <br />U.S. HealthWorks, Inc. INSURER 6: Hartford Fire Insurance Company 19682 <br />3655 North Point Parkway, Suite 150 INSUAERC: Hartford Insurance Company ofthe Midwest 37478 <br />Alpharetta, GA 30005 <br /> INSURER D: <br /> INSURER E: <br /> <br />COVERAGES <br /> <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br /> MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL iHE iEAMS, EXCLUSIONS AND CONDITIONS OF SUCH <br /> POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />I~~ r.!:D' ~DD nD POLICY NUMBER POUCYEFFECTlVE POt.ICYEXPIRATJON UMITS <br />A f.E5NERAL UABIUTY 72UENUM8309 09/01105 09/01106 EACH OCCURRENCE , 1,000,000 <br /> X COMMERCIAL GENERAL LIABILITY ~~~~~~S YEa oce ranee $ 3OQ,OOQ <br /> I CLAIMS MADE 0 OCCUR MED EXP (Anyone ""'rson) $ 10,000 <br /> ~ PERSONAL & ADV INJURY $ 1,000,000 <br /> ~ GENERAL AGGREGATE $ 3,000,000 <br /> n'L AGG:Er~E LIMIT APFilIPER: PRODUCTS -COMP/OP AGG $ 3,000,000 <br /> POLICY 1~J"'p,: X LOG <br />B ~TOMOBILE LIABILITY 72UENUM8309 09101105 09/01106 COMBINED SINGLE LIMIT <br /> {Eaaccident} $ 1.000,000 <br /> ~ ANY AUTO <br /> ~ ALL OWNED AUTOS 60DIL Y INJURY <br /> $ <br /> ~ SCHEDULED AUTOS (Per parson) <br /> ~ HIRED AUTOS BODILY INJURY <br /> $ <br /> ~ NON-OWNED AUTOS {Peraeeiden,> <br /> PROPERTY DAMAGE $ <br /> (Per accident) <br /> ~~GEUABIUTY AUTO ONLY. EA ACCIDENT $ <br /> ANY AUTO OTHER THAN EA ACC $ <br /> AUTO ONLY: AGG $ <br />A ~~SSlUMBRELlA LIABILITY 72XHUTQ5969 09/01/05 09101106 EACH OCCURRENCE $ 10,000,000 <br /> X OCCUR D CLAIMS MADE AGGREGATE $ 10,000,000 <br /> $ <br /> ~ ~EDUCTIBLE $ <br /> X RETENTION $10000 $ <br />C WORKERSCOMPENSATlON AND 72WNMG3070 09/01/05 09101/06 X!T~:;;~J~IIt~ J IO;,!;!- <br /> EMPLOYERS' LIABILITY 1,000,000 <br /> ANY t" ROPRiETOR/PARTt.lER/iOXCCUTIVE: E.l. EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? E.L. DISEASE - Ell. f;MPLOYEE $ 1,000,000 <br /> ~P~~~~~~~~bNS below E.l. DISEASE - POLICY LIMIT $ 1,000,000 <br /> OTHER <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES J EXCLUSIONS ADDED BY ENDORSEMENT f SPECIAL PROVISIONS <br />"Except 10 days notice for non-payment of premium. RE: 1530 EAST EDINGER, SANTA ANA, CA 92705 "--/-<>/1' . <br /> ~ / "'~ <br /> ,~' .J- /-_".~I-:~~_/ 11< <br /> /' ' . #'/ <br /> , <br /> <br />CERTIFICATE HOLDER <br /> <br />CANCELLATION <br /> <br /> SHOULD ANY OF THE ABOVE DESCRIBED PQUCIES BE CANCELLED BEFORE THE EXPIRATION <br /> OATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITlEN <br />City of Santa Ana NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO so SHALL <br /> IMPOSE NO OBUGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />20 Civic Center Plaza REPRESENTATIVES. <br />Santa A~a, CA 92701 AUTHORIZED REPRESENTATIVE ~cR- '- <br /> <br />ACORD 25 (2001108) <br /> <br />@ACORDCORPORATION19~ <br />