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,4coRtr CERTIFICATE OF LIABILITY INSURANCE Date (ffnVd°/ri) <br />Producer <br />8/17/2009 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS U <br />PON THE CERTIFICATE HOLDER. <br />Wood Gutmann & Bogart Insurance Brokers THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE <br />15901 Red Hill Ave., Suite 100 COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Tustin, CA 92780 INSURER I <br />INSURER Hartford Casualty Insurance Company <br />714 50.7000 License No. 0679263 <br />www.w 5bib.com INSURER American Casualty Company of <br />Reading, PA <br />Insured <br />INSURER <br />Pulmonary Consultants & Primary Care <br />Physicians Medical Group, Inc. INSURER <br />1310 W. Stewart Dr ive #410 <br />Orange CA 92868 INSURER <br />E <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. <br />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 <br />TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS- <br />LTR <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />`1 1" ` <br />[AVIKA I IUN <br />A <br />GENERAL LIABILITY <br />72SBAIA4429 <br />MNUDATE <br />MM DE <br />LIMITS <br />A <br />COMMERCIAL GENERAL UAB <br />72SBAIA4429 <br />5/1/2009 <br />5/1/2010 <br />EACH OCCURRENCE s <br />FIRE DAMAGE one fire) <br />$ <br />NON -OWNED AUTOS <br />CLANS MADE OCCUR <br />BODILY I W URY <br />(Per accident) <br />MED EXP lAnv ore Micn..l <br />c <br />Y F--" y5 TO FORM <br />Certificate holder is named as additional insured as per the above specifications. <br />Laura Stitt Sheedy <br />Assistant City Attorney <br />CERTIFICATE HOLDER CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL <br />City of Santa Ana X30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE <br />Attn: Roberta LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION <br />20 Civic Center Plaza OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRE- <br />Santa Ana CA 92702 SENTATIVES. ' 10 Days for Nonpayment of Premium. <br />ACORD 25 -S (7/97) <br />CERT NO.: 5574206 Angelina Garcia 8/17/2009 11:38:13 AM Page 1 of 2 <br />Peters tl - 4e�- <br />© ACORD CORPORATION 1988 <br />na.icr OJECT LOC <br />A <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />72SBAIA4429 <br />5/1/2009 <br />5/1/2010 <br />COMBINED SINGLE LIMIT <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />HIRED AUTOS <br />BODILY INJURY <br />(P �+SOn) <br />NON -OWNED AUTOS <br />BODILY I W URY <br />(Per accident) <br />PROPERTY DAMAGE <br />GARAGE LIABILITY <br />(Per accident) <br />ANY AUTO <br />AUTO ONLY - EA ACCIDEI <br />OTHER THAN <br />AUTO ONLY: <br />A <br />EXCESS LIABILITY <br />OCCUR FICLAIMSMADE <br />72SBAIA4429 <br />5/1/2009 <br />5/1/2010 <br />EACH OCCURRENCE <br />AGGREGATE <br />DEDUCTIBLE <br />RETENTm S 10,000 <br />BEM <br />WORKS S' OL P NSSATION IL <br />4012325181 <br />10/1/2008 <br />10/1/2009 <br />STATUTORDENT <br />EL EACH ACCIDENT <br />EL DISEASE - EA EMPLOYI <br />Y F--" y5 TO FORM <br />Certificate holder is named as additional insured as per the above specifications. <br />Laura Stitt Sheedy <br />Assistant City Attorney <br />CERTIFICATE HOLDER CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL <br />City of Santa Ana X30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE <br />Attn: Roberta LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION <br />20 Civic Center Plaza OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRE- <br />Santa Ana CA 92702 SENTATIVES. ' 10 Days for Nonpayment of Premium. <br />ACORD 25 -S (7/97) <br />CERT NO.: 5574206 Angelina Garcia 8/17/2009 11:38:13 AM Page 1 of 2 <br />Peters tl - 4e�- <br />© ACORD CORPORATION 1988 <br />