CORRECTIONAL MANAGED CARE MEDICAL CORPORATION 5b - 2009

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ACORL�M CERTIFICATE OF LIABILITY INSURANCE PRODUCER �g49�305 -6161 FAX �949�305 -6166 THIS CERTIFICATE IS ISSUED AS A MATTER CO7onial Western Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE 26691 Plaza Drive, Suite 220 HOLDER. THIS CERTIFICATE DOES NOT AME ALTER THE COVERAGE AFFORDED BY THE Mission Viejo, CA 92691 DATE (MM /DDM'YY) EXTEND OR INSURERS AFFORDING COVERAGE NAIC # INSURED Correctional Managed Care Medical Corporation INSURERA: Landmark American Insurance Comp ny 4211 E. La Palma Ave. INSURER e: Travelers Insurance Company Anaheim, CA 92807 //�� p, INSURER C: Everest Insurance Company /-T — � ��+ / — �(�/ _ INSURER D: �P INSURER E: COVERAGES 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_ VSR _TR DD' NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM /DD/YVW POLICY EXPIRATION DATE MM /DD/YYYY LIMITS GENERAL LIABILITY X COMMERCIAL GENERAL LU\BILITY X CLAIMS MADE � OCCUR LHC812193 08/01/2009 08/01/2010 EACH OCCURRENCE $ 1, 000 , 00 PREMISES Ea occurrence $ SQ QQ MED EXP (Any one person) $ S , QQ A PERSONAL 8 ADV INJURY $ 1 , OOO , OO GENERAL AGGREGATE $ 3 , OOO , OO GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC PRODUCTS - COMP /OP AGG $ 1 , OOO , OO B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON- OWNED.,/�U -yTOS g p F �Jr �+,� " ^:�a ,.� �� 6809447H706 - ��/ ` e �� Q.�L- r I r �� ` ( 02/04/2010 � �� ��/ \� Q2/Q4/2Q11 L ��` iiii ```��— ' � COMBINED SINGLE LIMIT (Ee accident) $ 1 � QUQ � 00 BODILY INJURY (Par peraon) $ X BODILY INJURY (Per eeeiCent) $ X PROPERTY DAMAGE (Per accident) $ GARAGE LV\BILITY ANY AUTO /-/ C` T �y�y'� ry - -t,� A V TO IZM AVTO ONLY -EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: qGG $ $ EXCE89 /UMBRELLA LU\BILITY OCCUR � CLAIMS MADE rney EACH OCCURRENCE $ y Odge eputy ty Att AGGREGATE $ $ DEDUCTIBLE $ _ RETENTION $ C WORKERS COMPENSATON AND EMPLOYERS' LIABILITY Y / N OFFICER/MEM ER EXCLUOED7 ECUTIVE� (Mandatory In NH) If es, describe under SPECIAL PROVISIONS below CA20010955091 07/01/2009 07/01/2010 X TORY LIMITS ER E.L. EACH ACCIDENT $ 1 , OOO , OO E.L. DISEASE - EA EMPLOYEE $ 1 ,QUQ , QQ E.L. DISEASE - POLICY LIMIT $ 1 QQQ QQ '4 ro�`essional Liability dodged Care E80 Liab. LHC812193 LHC812193 08/01/2009 08/01/2009 08/01/2010 08/01/2010 Prof Liability: $lmil /$$mil Managed Care E80: $imil /$$mil IESCRIPTION OF OPERATIONS / LOCATON3 /VEHICLE$ /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISION8 10 Days notice of cancellation for non - payment of premium. ertificate Holder is an Additional Insured for general liability and professional liability per ndorsements Additional Insured - Designated Person or Organization & Waiver of Transfer f Rights of Recovery Against Others To Usk attached. City of Santa Ana 62 Civic Center Plaza Santa Ana, CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRAT101 DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL '°'3O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 30 SHALL IMPOSE NO OBLIGATION OR LU\BILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Tha ACORD name and logo are registered marks of reserved.