WESTERN MEDICAL CENTER OF SANTA ANA (WMC-SA) 1B - 2008

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-," ,- ACORD* CERTIFICATE OF LIABILITY INSURANCE OP 10 S~ DATE (MMlDDIYYYY) WMCSA01 03/26/08 , PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Haake Companies A-2008-089 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 4650 College Blvd., Suite 300 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Overland Park KS 66211 Phone: 913-491-1999 Fax: 913-906-0088 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Lexington Insurance Company INSURER B: WMC-SA1 Inc. d/b/a Western INSURER c: Medi.ca Center - Santa Ana 1001 North Tustin Avenue INSURER 0: Santa Ana CA 92705-3502 INSURER E: COVERAGES THE POlICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR 'THE POLICY PERIOD INDICATED. NOlWlTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER OOCUMENT 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. LTR NSR[ TYPE OF INSURANCE POLICY NUMBER DATE IMMlDDIYYJ I'MT'E'(M"h~N LIMITS GENERAL LIABILITY EACH OCCURRENCE $ - 04/01/08 04/01/09 A X COMMERCIAL GENERAL LIABILITY 6794437 PREMISES lEa occurence) $ - :J CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ - X Healthcare CLAIMS MADE PERSONAL & ADV INJURY $ Professional Liab 3-8-05 GENERAL AGGREGATE $ GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS, COMP/OP AGG $ I POLICY n ~f~ n LOC SEE BELOW ** AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $N/A - ANY AUTO (Ea accident) - ALL OWNED AUTOS BODILY INJURY $N/A - SCHEDULED AUTOS (Per person) - HIRED AUTOS BODILY INJURY $N/A - NON-OWNED AUTOS (Per accidenl) - PROPERTY DAMAGE $N/A (Per accidenl) GARAGE LIABILITY AUTO ONLY, EA ACCIDENT $N/A R ANY AUTO OTHER THAN EA ACC $N/A AUTO ONLY: AGG $N/A EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 5,000,000 A I!J OCCUR ~ CLAIMS MADE 6794437 04/01/08 04/01/09 AGGREGATE $ 5,000,000 $ SEE BELOW* * R DEDUCTIBLE RETRO $ RETENTION $ DATE $ 3-8-05 WORKERS COMPENSATION AND ITORYLlMlTSl jU~lt EMPLOYERS' LIABILITY $N/A ANY PROPRIETORIPARTNERlEXECUTIVE E.L. EACH ACCIDENT OFFICERlMEMBER EXCLUDED? E.L. DISEASE, EA EMPLOYEE $N/A ~~~:s~~V1~~S below E.L DISEASE, POLICY LIMIT $N/A OTHER ,'" IlESCR/POON OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS ;et~1 (/"2- ** EXCESS LIMIT IS OVER: $2,000,000/$10,000,000 HEALTHCARE PROFESSIONAL LIABILITY AND COMMERCIAL GENERAL LIABILITY. THE CITY OF SANTA ANA, ITS / '- -.'- OFFICERS , EMPLOYEES ,AGENTS, VOLUNTEERS AND REPRESENTATIVES ARE INCLUDED AS ADDITIONAL INSUREDS ON THE GENERAL LIABILITY BUT ONLY AS RESPECTS THE INSUREDS OPERATIONS. ::ERTIFICA TE HOLDER CLERK OF THE CITY COUNCIL CITY OF SANTA ANA 20 CIVIC CENTER PLAZA (M-30) PO BOX 1988 SANTA ANA CA 92702-1988 CANCELLATION CTYSTAN SHOUlD AP('( 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. ESENTATIV @ ACORD CORPORATION 1988 ICORD 25 (2001J08)