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A ^r1A11 <br />CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MM /DD/YYYY) <br />08/03/2010 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />Colonial Western Insurance Agency <br />26691 Plaza Drive, Suite 220 <br />Mission Viejo, CA 92691 <br />NAME: <br />AICO "N EXt:(949)305 -6161 aCNo:(949)305 -6166 <br />E -MAIL <br />ADDRESS: <br />PRODUCER <br />CUSTOMER ID #: <br />INSURER(S) AFFORDING COVERAGE NAIC # <br />INSURED <br />Correctional Managed Care Medical Corporation <br />4211 E. La Palma Ave. <br />Anaheim, CA 92807 <br />/,/�� /� /� (�/� <br />I +f - 2,voq - I 1 v� <br />INSURERA: Landmark American Insurance Company <br />B: Travelers Insurance Company <br />-INSURER <br />INSURER C: Everest Insurance Company <br />INSURER D: <br />INSURERE: <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: Ci tY of Santa Ana REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />INSR <br />SUBR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MM /DD/YYYY <br />POLICY EXP <br />MM /DD/YYYY <br />LIMITS <br />A <br />GENERAL LIABILITY <br />X COMMERCIAL GENERAL LIABILITY <br />X CLAIMS -MADE F—I OCCUR <br />Salta Ana, CA 92702 <br />Don <br />LHC81448 <br />08/01/2010 <br />08/01/2011 <br />EACH OCCURRENCE <br />$ 1,000,000 <br />DAMAGE TO RENTED <br />PREMISES Ea occurrence <br />$ 5O 000 <br />s <br />MED EXP (Any one person) <br />$ 5,000 <br />PERSONAL & ADV INJURY <br />$ 1,000,000 <br />GENERAL AGGREGATE <br />$ 3,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY PR0 JECT LOC <br />PRODUCTS - COMP /OP AGG <br />$ 1,000,000 <br />$ <br />B <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />APPROVE <br />6809447H70 <br />AS T0110(?NTEPT <br />!f f <br />02/04/2010 <br />02/04/2011 <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />$ 1,000,000 <br />BODILY INJURY (Per person) <br />$ <br />BODILY INJURY (Per accident) <br />$ <br />PROPERTY DAMAGE <br />(Per accident) <br />$ <br />X <br />X <br />$ <br />$ <br />UMBRELLA LIAR <br />EXCESS LIAB <br />OCCUR <br />CLAIMS -MADE <br />t <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />DEDUCTIBLE <br />RETENTION $ <br />$ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />ANFICER/MEMBER EXCLUDED? ECUTIVE � <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />CA20010955101 <br />07/01/2010 <br />07/01/2011 <br />X TORY LATI -1 ER <br />E.L. EACH ACCIDENT <br />$ 1,000,000 <br />E.L. DISEASE - EA EMPLOYEE <br />$ 1,000,000 <br />E.L. DISEASE - POLICY LIMIT <br />$ 1,000,000 <br />A <br />Professional Liability <br />Managed Care E&O Liab. <br />LHC81448 <br />LHC81448 <br />08/01/2010 <br />08101/2010 <br />08/01/2011 <br />08/01/2011 <br />Prof Liability: $lmil /$3mi1 <br />Managed Care E&O: $lmil /$3mil <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101 Additional Remarks Schedule, if more space is required) <br />30 Days notice of cancellation, 10 days for non - payment of premium. <br />Certificate Holder is an Additional Insured for general liability and professional liability per <br />endorsements (Additional Insured - Designated Person or Organization & Waiver of Transfer <br />f Rights of Recovery Against Others To Us) attached. <br />CERTIFICATE HOLDER CANCELLATION <br />1 8 -2009 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2009/09) The ACORD name and logo are regist arks of ACORD <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />City of Santa Ana <br />AUTHO REPRESENTATIVE <br />62 Civic Center Plaza <br />nEmory <br />Salta Ana, CA 92702 <br />Don <br />1 8 -2009 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2009/09) The ACORD name and logo are regist arks of ACORD <br />