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<br />ACORD,. CERTIFICATE OF LIABILITY INSURANCE I DATE{MMlDDIYYYY) <br />101712004 <br />PRODUCER (800) 733-4474 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />GALLAGHER HEAL THCARE INSURANCE SERVICES, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />ONE BRIAR LAKE PLAZA, SUITE 2000 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />2000 WEST SAM HOUSTON PARKWAY SOUTH ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />HOUSTON, TX 77042 INSURERS AFFORDING COVERAGE NAlC # <br />INSURED INSURER A: THE DOCTORS COMPANY 1BOB3 <br />U.S. HEAL THWORKS, INC. INSURER B: <br />3655 NORTH POINT PARKWAY, SUITE 150 INSURER C: <br />ALPHARETTA, GA 30005 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,NOlWITHSTAN01NG <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 BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br /> POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />I~i'~ ~~~L p~;~y ~:~~~E POLICY EXPIRATION LIMITS <br />TYPE OF INSURANCE POLICY NUMBER DATE MM/DDNY <br />~NERAL LIABILITY EACH OCCURRENCE NIA <br /> COMMERCIAl. GENERAL L1ABLITY ~~~~~~~E~E~~~~RENCE'" N/A <br />- =.J CLAIMS MADE DOCCUR MED EXP (Anyone pElrwn) NIA <br /> PERSONAL & AOV INJURY N/A <br /> GENERAL AGGREGATE N/A <br />~N~L AGGREA ~~': APp~r PER: PRQDUCTS _ COMP/OP AGG N/A <br /> POLICY JECT LOC <br />~TOMOBilE LIABilITY COMBINED SINGLE LIMIT N/A <br /> (EaaOOdent) <br />- ANY AUTO <br />- ALL OWNED AUTOS BOOIL Y INJURY N/A <br /> (Per person) <br />- SCHEDULED AUTOS <br />- HIRED AUTOS BODILY INJURY N/A <br /> (Peracddent) <br />- NON.OWNED AUTOS <br /> PROPERTY DAMAGE N/A <br /> (Peracddent) <br />~AGE UAS,un AUTO ONLY _ EA ACCIDENT NIA <br /> ANY AUTO OTHER THAN EAACC N/A <br /> AUTO ONLY: AGG N/A <br />EXCESS/UMBRELLA LJABJ1.JTY EACH OCCURRENCE N/A <br />=::J OCCUR 0 CLAIMS MADE AGGREGATE N/A <br /> N/A <br />=i:DUCT"" N/A <br /> ETENTlON NIA <br /> WORKERS COMPENSATION MID I WCSTATU., I <\ OTH. <br /> EMPLOYERS'LIABJLJTY )( TDRY LIMiTS X ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT NIA <br /> OFFICER/MEMBER EXCLUDED? N/A <br /> ~ yes, describe under EL DISEASE: _ EA EMPLOYEE: <br /> SPECIAL PROVISIONS below E,L. DISEASE - POLICY LIMIT N/A <br /> OTHER 1,000.000 PER CLAIM <br />A MEDICAL PROFESSIONAL 69727 05101105 05101106 3,000,000 ANNUAL AGGREGATE <br /> LIABILITY - CLAIMS MADE DEDUCTIBLE $100.000 PER CLAIM <br />DESCRIPTION OF OPERATlONSILOCATIONSIVEHICLES/EXCLUSIONS ADDEO BY ENDORSEMENT/SPECIAL PROVISIONS <br />MEDICAL PROFESSIONAL RETROACTIVE DATE: 1010111995 w <br /> ^ - <br /> ,{-/ It <br /> 1/ ", ^", <br /> 'p.Jt \';t' { 11 '-'-. <br /> ,,;,. <br />CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE;: ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> CITY OF SANTA ANA DATE THEREOF, THE ISSUIK13 IKSURER WILL ENDEAVOR TO MAIL .....H.. DAYS WRITTEN NOTICE <br /> 20 CIVIC CENTER PLAZA TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL IMPOSE NO <br /> SANTA ANA, CA 92701 OBLIGATION OR LIABILITY 0' AN' KINO UPON THE INSURER:, ,,. AGENTS OR <br /> REPRESENTATIVES, <br /> AUTHORIZED REPRESENTATIVE <br /> <':"7 /52. <br /> r~ -;) ''''- ~------------ <br /> ,~L <br /> ,~~,-._-,~- -"--' <br /> <br />ACORD 25 (2001/OB) <br /> <br />@ACORD CORPORATION 19BB <br />