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<br />ACQBJ:t
<br />
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />I
<br />i
<br />i
<br />
<br />DATI' {MM,POIY)''(Y)
<br />10/19!2006
<br />
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
<br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
<br />
<br />PRODUCER
<br />Arthur J, Gallagher & Co.
<br />License #0726293
<br />505 North Brand Blvd, Suite 600
<br />Gler;t:Jale, CA 91203.3944
<br />Phone_ 818,539-2300 rme 818,.539-230,
<br />
<br />INSURERS AFFORDING COVERAGE
<br />
<br />NAIC#
<br />
<br />IN$'JRED
<br />U.S. HealthWorks, Inc.
<br />3655 North Point Parkway, Suite 150
<br />A!pharetta, GA 30005
<br />
<br />INSUREr< A _,!j~~~?_~i:!,!:iE:.,l0.~~E~0,~,~_S~9!':"P~ ny
<br />INSUR,,;:'l a Hartford
<br />
<br />IP,SJRER D
<br />IN$JRFRf
<br />
<br />COVERAGES
<br />
<br />THE POLICiES O~ iNSURANCE LISTED BELO'N H/IVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERiOD INDIC,\TED NOTVi!THSTANDING
<br />ANY REQUIREMENT, TERM OR CONDITiON Or: ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE r.,'AY BE ISSUED OR
<br />MAY PERTAIN, THE !NSURANCE- AFFORDED BY THE POLJCIES DESCRI8ED HEREIN JS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH
<br />POLlCES, AGGREC',ATE LIMITS SHOWN r.1AY HAVE BEEN REDUCED BY PAID CLAJMS.
<br />
<br />^
<br />"
<br />
<br />
<br />72UENUM8309
<br />
<br />
<br />LIMITS
<br />
<br />09/01106
<br />
<br />09/01/07
<br />
<br />_,~i:~gg;::!,~H~,I\PVI~.JURY
<br />q?t_~:")~LA:q<:;!'lS(;ATC
<br />
<br />300,00G
<br />10,000
<br />'1,000,000
<br />3,000,000
<br />3.:;)00,'060
<br />
<br />CCCUR
<br />
<br />I'~/(r ,;"'p:d~S "iiiK
<br />
<br />A
<br />
<br />
<br />POliCY
<br />
<br />09/01107
<br />
<br />1 ,000.000
<br />
<br />ANY AUTO
<br />
<br />A.LlCWVNE~AJT()..,>
<br />
<br />BODilY IN...'URY
<br />lPeqxvUJI!
<br />
<br />X SC!,EOU",PCAUTOS
<br />X
<br />X
<br />
<br />H)I~f.:; AUTOS
<br />
<br />BO(}ll Y IN.;;JRY
<br />li'tHaccid(l1)1;
<br />
<br />I\ON.owr;;:[;AUros
<br />
<br />GII.:RAGE LIABILITY
<br />
<br />AuTOO....L Y .f:.AACClQEN1
<br />
<br />ANY Al!f(,
<br />
<br />OTHER'rH^,"
<br />AiJTOONLY
<br />
<br />G
<br />
<br />,_ €XCESS!iJMBREL ~~1~6IL1T Y
<br />
<br />09/0'1/06
<br />
<br />09101;07
<br />
<br />X OCCUR
<br />
<br />: 0_AIM$ MADE
<br />
<br />~~~~::;;;:~,!E
<br />
<br />D~DUCT-i>:~E
<br />X R[TF'H'O'1
<br />
<br />S 10000
<br />
<br />^ WORl{ERS COMPENSATION ANO
<br />EMPLOYERS' LlABIUTY
<br />
<br />72WNi',.1G3070
<br />
<br />09(0 1 1lJ6
<br />
<br />09;01/07
<br />
<br />X
<br />
<br />~,::L^, ~t:Cl1 ACCIDeNt
<br />
<br />is ~" YSEASE. ;'OUCY!.i'tiT
<br />
<br />1,000,000
<br />1,000,000
<br />
<br />OTHER
<br />
<br />- .----.- .--
<br />DESCRIPTION Of' OPERA nO~lS.' LOCATIONS i VEHICLES! EXCLUSIONS AOoeo &V ENDORSEMENT I SPECIAL PROVISIONS
<br />'Except ~o days notice for r,on-poyrr)l;ml of premium The City 01 Santa Ana. 20 Civic Center Plaza, Santa J\na, California 92;'0'1. its officers, employees.
<br />agents volunteers and represontatives are named as additior,QI insureds with regard to liability ar:d defense of suits arising from the operations and uses
<br />performed by or on behalf of the namBd ifl$!Jred.
<br />
<br />CERTIFICATE HOLDER
<br />
<br />CANCELLATION
<br />
<br />20 OAc Center Pklza
<br />S.an:",1 Ana. C/\ 92701
<br />
<br />
<br />SHOULD ANY OF THE ABOVE OESCRlIlEO POLICIES 6f CANCELLED BEFORE THE EXPlRA TlON
<br />OATe THEREOF, THE ISSUING INSUReR WILL XXXXXXl<.XXXXMAlt. ,,,;?St,, DAYS WR:rrTEN
<br />~~:pfi Tp THE CERTifICATE HOLOER NAMEO TO THE lEFT, XXXXYJ0lXXx.xXXXXXXXXXXXX
<br />l.iJ...!:xiidXyy'XXJ(xXXXXXX:XXXXXXXXxYJOC';XXXXXXXXXXXXXXXXXXXXX;<.XXXXXXXXXxxxx.>:
<br />XXYJ;XXXXMXXXXX
<br />AUTHORIZEO REPRESEtHATlVE
<br />
<br />City of Santa An;)
<br />City of Santa An~l Fire DepiOrtmeh!
<br />
<br />A:!ll'lltb'VtH::I AS '1'0
<br />
<br />~
<br />
<br />ACORD 25 (2001108)
<br />
<br />@ ACORD CORPORATION 1988
<br />
<br />L. c,
<br />
<br />
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