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08/01/2008 15:42 19493056166 COLONIAL PRA PAGE 01/03
<br />�BD,M CERTIFICATE OF LIABILITY INSURANCE DATE,M"'°°OC
<br />PRODUMA (94q,);Q5-6161 FAX 08/01/2008
<br />(949)30-G1GG THIS CERTIFICATE IS ISSUED _ASA MATTER OF INFORMATION
<br />Colonial Western Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />26691 Plaza Drive, Suite 220 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />Ri33ion Viejo, CA 92691 ALTF.RE COVERArF AFFORDED DY THE POLICIES DCLOW.
<br />INSURERS AFFORDING COVERAGE MAIC #
<br />INSURED Correct oval Managed Care M Kcal Corpnration INSuRr to
<br />Landmark American Insurance Corp ny
<br />V11E. La Palma Ave.
<br />Anaheim,
<br />INSURERS- Travelers Insurance Company
<br />Anaheim, CA 92607 y
<br />INSURERc, Everest Insurance Company
<br />INSURER 0,
<br />INSURER E;
<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 THE TERMS EXCLUSIONS AND CONDITIONS nF SUCH
<br />POI Ir.IFC ArrREGATE LIMITS SHOWN MAY I IAVC OCGN REDUCED DY PAID CLAIMS
<br />RR 140011TYPE OF INSURANCE POLICY EFFECTIVE POLICY EXPIRATION
<br />r "Min
<br />POLICY NUNrBER
<br />LIMITS
<br />GENERAL LIABILITY LHC909966 08/01/2008 08/01/2009 EACH OCCURRENCE c
<br />x COMMERCIAL GENERAL LIABILITY 11000,001
<br />DAMAGE 70 RF_NTEp S
<br />X CLAIMS MADE OCCUR ulyF�o „��,, wca 50 , 001
<br />A
<br />MED EXP (Any one Ream) S S.001
<br />GEN'L AGGAFOATE LIMIT APPLIES PER'
<br />roucv Pt a Loc
<br />AUTOMOORZ LIABILITY
<br />ANY AUTO
<br />ALL OWNED AUTOS
<br />8 SCHEDULEDAUTOS
<br />X HIRED AUTOR
<br />X NON-OWNEOAUTOS
<br />GARAGE LIABILITY
<br />I ANY AUTO
<br />EXCEBBIUMBRELLA LIABILITY
<br />OCCUn ❑ CLAIMO MADE
<br />_ DEDUCTIBLE
<br />RETENTION S
<br />WORKERS COMPENSATION AND
<br />EMPLOYERS• LIABILITY
<br />C ANY VNVVKIt WKIVARTNERIEXECUTIVE
<br />OFFICER/MEMBER EXCLUDED'?
<br />It y99, dnQlCe under
<br />SPECIAL PROVISIONS bolew
<br />AOTuu
<br />rressional Liability
<br />anaged Care E810 Liab.
<br />E L. cncn ACL.IMN 1 S 1,000,0C
<br />E L DISEASE - EA EMPLOYEE S I Mo. (K
<br />El DISEASE -POLICY LIMIT S 1,000, Oa
<br />5"Ci109966 08/01/2008 08/01/2009 Prof Liability: Slmil/$3mil
<br />LHC809966 08/01/2008 08/01/2009 Managed Carg E80; $Imil/13mil
<br />DESCRIPTION OF OPERATIONS I LOCATION¢ (VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
<br />10 Days notice of cancellation for non-payment of premium.
<br />:ertificate Holder is an Additional Insured for general liability and professional liability per
<br />,ndorsements (Additional Insured - Designated Person or Organization & Waiver of Transfer
<br />If Rights of Recovery Against Others To Us) attached.
<br />City of Santa Ana
<br />62 Civic Center Plaza
<br />Santa Ana, CA 92702
<br />%CORD 25 (2001108)
<br />RNnlI1 In ANY nF THE ABOVE OCCCRIDKO POLIC16e HE CANCCLLCP DCr'ORC TI Ic
<br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
<br />330 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
<br />BUT FAILURE TO MAIL SUCH NOTICE SRALL IMPOSE NO OBLIGATION OR LIABILTTY
<br />OF ANY KIND U THE INSURER, RS AGENTS OR REPRESENTATIVES.
<br />AUTHORIZED REPR TATNE
<br />Don Emory , _L"ti.. it
<br />CORPORATION 1988
<br />PCRSONAL d AUV INJUNT
<br />8 1
<br />GENERALAGGREGnTE
<br />PROOVCTS -COMP/OP AOG
<br />S 1
<br />6809447H706
<br />0.2/04/2008
<br />02/0$/2009
<br />coM91NEo SINGLE LIMIT
<br />(EA eCCldent)
<br />1
<br />BODILY INJURY �
<br />(Per Porson)
<br />a
<br />BODILY INJURY
<br />(Pe(accident)
<br />07/01/2008
<br />E L. cncn ACL.IMN 1 S 1,000,0C
<br />E L DISEASE - EA EMPLOYEE S I Mo. (K
<br />El DISEASE -POLICY LIMIT S 1,000, Oa
<br />5"Ci109966 08/01/2008 08/01/2009 Prof Liability: Slmil/$3mil
<br />LHC809966 08/01/2008 08/01/2009 Managed Carg E80; $Imil/13mil
<br />DESCRIPTION OF OPERATIONS I LOCATION¢ (VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
<br />10 Days notice of cancellation for non-payment of premium.
<br />:ertificate Holder is an Additional Insured for general liability and professional liability per
<br />,ndorsements (Additional Insured - Designated Person or Organization & Waiver of Transfer
<br />If Rights of Recovery Against Others To Us) attached.
<br />City of Santa Ana
<br />62 Civic Center Plaza
<br />Santa Ana, CA 92702
<br />%CORD 25 (2001108)
<br />RNnlI1 In ANY nF THE ABOVE OCCCRIDKO POLIC16e HE CANCCLLCP DCr'ORC TI Ic
<br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
<br />330 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
<br />BUT FAILURE TO MAIL SUCH NOTICE SRALL IMPOSE NO OBLIGATION OR LIABILTTY
<br />OF ANY KIND U THE INSURER, RS AGENTS OR REPRESENTATIVES.
<br />AUTHORIZED REPR TATNE
<br />Don Emory , _L"ti.. it
<br />CORPORATION 1988
<br />PROPFkTY nAMar:F
<br />(Per enc dent) 3
<br />�J
<br />AUTO ONLY. E.A ACCIDENT 5
<br />OTHER THAN CAADC a
<br />AUTO ONLY, AGG $
<br />EACH OCCURRENCE 1 $
<br />AGGREGATE I
<br />s
<br />5
<br />a
<br />CA20010955081
<br />07/01/2008
<br />07/01/2009
<br />T1n�/C�STA�U� o��-
<br />X
<br />E L. cncn ACL.IMN 1 S 1,000,0C
<br />E L DISEASE - EA EMPLOYEE S I Mo. (K
<br />El DISEASE -POLICY LIMIT S 1,000, Oa
<br />5"Ci109966 08/01/2008 08/01/2009 Prof Liability: Slmil/$3mil
<br />LHC809966 08/01/2008 08/01/2009 Managed Carg E80; $Imil/13mil
<br />DESCRIPTION OF OPERATIONS I LOCATION¢ (VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
<br />10 Days notice of cancellation for non-payment of premium.
<br />:ertificate Holder is an Additional Insured for general liability and professional liability per
<br />,ndorsements (Additional Insured - Designated Person or Organization & Waiver of Transfer
<br />If Rights of Recovery Against Others To Us) attached.
<br />City of Santa Ana
<br />62 Civic Center Plaza
<br />Santa Ana, CA 92702
<br />%CORD 25 (2001108)
<br />RNnlI1 In ANY nF THE ABOVE OCCCRIDKO POLIC16e HE CANCCLLCP DCr'ORC TI Ic
<br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
<br />330 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
<br />BUT FAILURE TO MAIL SUCH NOTICE SRALL IMPOSE NO OBLIGATION OR LIABILTTY
<br />OF ANY KIND U THE INSURER, RS AGENTS OR REPRESENTATIVES.
<br />AUTHORIZED REPR TATNE
<br />Don Emory , _L"ti.. it
<br />CORPORATION 1988
<br />
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