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<br />AC40R"
<br />` ,? CERTIFICATE OF LIABILITY INSURANCE DATE
<br />6/20/2M/DDI012
<br />6/20
<br />12
<br />PRODUCER (303) 534-7325 FAX: (303) 623-7325
<br />Peak 360, Inc.
<br />
<br />1600 Emerson St. ,n
<br />
<br />. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
<br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />HOLDER T I$$,,,,,,??RTIFICATE DOES NOT AMEND, EXTEND OR
<br />,^AL ECOII RAGE AFFORDED BY THE POLICIES BELOW.
<br />Denver CO 80218 INSURERS AFFQRpING COVERAGE NAIC #
<br />INSURED C , t INSURER A: Ho*14 5d Insurance Co of NY
<br />Wel lDyne , Inc.; WellDyneRX; CF Pharmacy Svc)5' , INSURER B: CC)nti? i 'ntal Insurance (CNA)
<br />7472 S. Tucson Way
<br />The Hartford
<br />INSURER C:
<br />00914
<br /> ©? a-731 INSURER D:
<br />Centennl al CO 80112 INSURER E:
<br />I1(11'1G D A (_G C
<br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
<br />TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
<br />ANY REQUIREMENT
<br />,
<br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OFSUCH
<br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR ADD'
<br />NSR
<br />TYPE OF INSURANCE POLICY NUMBER POLICYM EFFECTIVE
<br />DATE MIDD/YYYY POLICY EXPIRATION
<br />DATE MM/DD/YYYY LIMITS
<br /> GENERAL LIABILITY EACH OCCURRENCE $ 1 000 000
<br />
<br />X
<br />COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$ 300,000
<br />A CLAIMS MADE [A] OCCUR L-0925-11 12/7/2011 12/7/2012 MED EXP (Any one person) $ 5,000
<br />! PERSONAL & ADV INJURY $ 1,000,000
<br /> i GENERAL AGGREGATE $ 3,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: / PRODUCTS - COMP/OP AGG $ 3,000,000
<br /> 77 PRO-
<br /> X POLICY !
<br />LOC
<br /> AUT OMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br /> (Ea accident) $ 1,000,000
<br /> ANY AUTO
<br />B ALL OWNED AUTOS 4026985883 12/7/2011 12/7/2012 BODILY INJURY
<br /> X SCHEDULED AUTOS
<br />(Per person)
<br />$
<br /> X HIRED AUTOS BODILY INJURY
<br />$
<br /> X NON-OWNED AUTOS
<br />(Per accident)
<br /> -e-? PROPERTY DAMAGE
<br /> 3 (Per accident) $
<br /> -
<br /> GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
<br />
<br />ANY AUTO 1
<br />/
<br />OTHER THAN EA ACC
<br />$
<br /> AUTO ONLY: AGG $
<br /> EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ 2,000,000
<br /> X OCCUR CLAIMS MADE AGGREGATE $ 2,000,000
<br /> $
<br />A DEDUCTIBLE MFX-0251-11 12/7/2011 12/7/2012 $
<br /> X RETENTION $ 10,00 EXCESS OVER CNA ONLY $
<br />C WORKERS COMPENSATION WRYTATU- OT
<br />H-
<br /> AND EMPLOYERS' LIABILITY R
<br /> Y / N
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000
<br /> ?
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />34WEJI3046
<br />6/1/2012
<br />6/1/2013
<br />E.L. DISEASE - EA EMPLOYE
<br />$ 1 000,000
<br /> If yes, describe under
<br /> SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000
<br />A OTHER PROF LIABILITY L-0925-11 12/7/2011 12/7/2012 EACH OCCURRENCE $ 1,000,000
<br /> ANNUAL AGGREGATE $ 3,000,000
<br />C TPA E&O LIABILITY iPG0257328 12/7/2011 12/7/2012 1,000,000
<br />DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
<br />CERTIFICATE HOLDER CANCELLATION
<br />ckindig@santa-ana.org SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
<br />CITY OF SANTA ANA DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
<br />CHRI STY KIND IG NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
<br />20 CIVIC CENTER PLAZA
<br />SANTA ANA, CA 92701 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
<br /> REPRESENTATIVES.
<br /> AUTHORIZED REPRESENTATIVE _
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<br />ACORD 25 (2009/01) © 1988-2009 ACORD CORPORATION. All rights reserved.
<br />INS025 (200901) The ACORD name and logo are registered marks of ACORD
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