WITTMAN ENTERPRISES, LLC HIPAA BUSINESS ASSOCIATE AGREEMENT -2009

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v — wn itry I -ui ACORU. CERTIFICATE OF LIABILITY INSURANCE DATE NSR 718/2009) PRODUCE _do. '1e1`l81 (irl' ; ((1*A A741 Wells Fl Ingo of Catifbrriia Insurance Services Inc. 11017 Cobblerock Drive, Suite 100 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # iji�hc( �Jord�, C50 -� INSURED Wittman Enterprises, LLC INSURER A: Hartford Casualty Insurance Company 29424 INSURER B: National Fire Insurance Company of Hartford 20478 PO Box 269110 EACH OCCURRENCE INSURER c: Executive Risk Indemnity 35181 INSURER D: r Sacramento, CA 95826 lA \ICSw��c. INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT 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. INSR LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM D Y POLICY EXPIRATION DATE MM D Y ) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR 57SBAAT6490 07/01/2009 07/01/2010 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED $ 300.000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- JECT LOC PRODUCTS - COMP /OP AGG $ 4,000,000 B AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS B4012487490 07/01/2009 07/01/2010 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ ' GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ A EXCESS /UMBRELLA LIABILITY 7X OCCUR FI CLAIMS MADE DEDUCTIBLE X RETENTION $ 10,000 57SBAAT6490 07/01/2009 07/01/2010 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY AIJY PROPRIETOR/PARTNER/EXECU. IVE OFFICER /MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below OTHER Prof Liability 81716616 07/01/2009 07/01/2010 WC STATU- OTH- TORY LIMIT E.L. EACH ACCIDENT $ -- E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ $1,000,000/$1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS APPJk01Vqh1J FORM Certificate holder named additional insured per attached form SS0008 04/05, pages 18 -20. �, " 10 day notice applies if cancelled for non - payment of premium. y % Laura A ,. 5;icedy Assista� City Attorney i`C DTI Cl/�ATG LJf�I nrr • •. -. _ -.• .-. .. .. - .. _ City of Santa Ana 14139 Broadway :?anta Ana, CA 92701 ACORD 25 (2001!e31 i ns 9 661228 {�,/, /��J 9 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION -" ` �� • TIHE CERTIFICATE HOLDER NAMED T E'FfT,MAIl7Fzq'pgS WRITTEN I I�RJ�t41X�XC74TJOLtJOBC Em6' B�ORXx�X1KNXNl4NDk�lN�iB�SOBBRSXRXX�BI�B (fiRxx AUTHORIZED REPRESENTATIVE W AL UKU GvKVVKAIIVN 1958 (This certificate replaces certifcate# 625376 issued on 6/26/2009)