PULMONARY CONSULTANTS & PRIMARY CARE PHYSICIANS MEDICAL GROUP, INC. 4B - 2009

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t 121r`ALl c;UKNURATION 1988 CERT NO.: 6088189 Noele Barer 10/27/2009 10:38:17 AM Page 1 of 2 ACORO" CERTIFICATE OF LIABILITY INSURANCE Date(mm /dd /yy) Producer Wood Gutmann & Bogart Insurance B ,'fa, ervill/ 15901 Red Hill Ave., Suite 100 Tustin, CA 92780 10/27/2009 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. C THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFF RDIN COVERAGE iroSVFR R Hartford Casualty Insurance Company f =i L 1 1j' 714 505.7000 License No. 0679263 L'- www.wgbib.com NSUkER American Casualty Company of Reading, PA Insured Pulmonary Consultants & Primary Care Physicians Medical Group, Inc. 1310 W. Stewart Dr ive #410 Orange CA 92868 INSURER INSURER D NSURER E COVERAGES THE NOTWITHSTANDING CERTIFICATE TERMS, INSR LTR • POLICIES OF INSURANCE ANY REQUIREMENT, MAY BE ISSUED EXCLUSIONS AND CONDITIONS TYPE OF INSURANCE GENERAL LIABILITY COMMERCIAL GENERAL LIAB CLAIMS MADE OCCUR LISTED BELOW HAVE BEEN TERM OR CONDITION OR MAY PERTAIN, THE INSURANCE OF SUCH POLICIES. POLICY NUMBER 72SBAIA4429 ISSUED AGGREGATE TO THE INSURED OF ANY CONTRACT AFFORDED BY LIMITS POLICY EFFECTIVE DATE MM /DD /YY 5/1/2009 NAMED ABOVE OR OTHER DOCUMENT THE POLICIES DESCRIBED SHOWN MAY HAVE POLICY EXPIRATION DATE MM /DD /YY 5/1/2010 FOR THE POLICY PERIOD INDICATED. WITH RESPECT TO WHICH THIS HEREIN IS SUBJECT TO ALL THE BEEN REDUCED BY PAID CLAIMS. LIMITS EACH OCCURRENCE $ 2,000,000 FIRE DAMAGE (An one fire) $ 300,000 MED EXP (An one person) $ 10,000 PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGG LIMIT APPLIES PER GENERAL AGGREGATE $ 4,000,000 • POLICY PROJECT LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 72SBAIA4429 JJ�jjjj��,� AO fry, , _ YY fLh' 5/1/2009 rf O 5/1/2010 PRODUCTS - COMP /OP AGG $ 4,000,000 COMBINED SINGLE LIMIT $ $ 2'000'000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ AMAGE GARAGE LIABILITY ANY AUTO {, As ��V sjst$ht ��lc$ - EA ACCIDENT FIACHOCCURRENCE "$1 EA A ONLY A RENCE A EXCESS LIABILITY OCCUR CLAIMS MADE C. 72SBAIA4429 5/1/2010 AGGREGATE $ 1,000,000 $ DEDUCTIBLE $ RETENTION $ 10 00 WORKERS' COMPENSATION & B EMPLOYERS' LIABILITY 4012325181 $ 10/1/2009 10/1/2010 STATUTORY LIMIT THER EL EACH ACCIDENT $ 1,000,000 EL DISEASE - EA EMPLOYEE $ 1 000,000 A Business Personal 72SBAIA4429 Property Including Coll Liter & Media EL DISEASE - POLICY LIMIT $ 1 no0 ono 5/1/2009 5/1/2010 $2,725,000 Limit of Insurance $1,000 Deducible, Special Form DESCRIPTION OF OPERATION S /LOCATIONS /VEHI LES /EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS Certificate holder is named as additional insured as per policy form IH 1200 11/85 and per specifications of the policies named above. CERTIFICATE HOLDER CANCELLATION City of Santa Ana Attn: William Watson 20 Civic Center Plaza Santa Ana CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE %7 EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRE- SENTATIVES. 10 Days for Non - Payment of Premium. AUTHORIZED REPRESENTATIVE Blane Peters ACORD 25 -S (7197) 121r`ALl c;UKNURATION 1988 CERT NO.: 6088189 Noele Barer 10/27/2009 10:38:17 AM Page 1 of 2