U.S. HEALTHWORKS 3 - 2009 - Laserfiche WebLink

Home Browse Search

IV ~ {CSI I ACORD,~ CERTIFICATE OF LIABILITY INSURANCE s/i/2oio DATE (MMlDDlYYYY) 4/28/2009 PRODUCER LOCKTON COMPANIES, LLC 5847 SAN FELIPE, SUITE 320 HOUSTON TX 77057 866-260-3538 THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES N07 AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED U. S. HEALTHWORKS, INC. ENSURER A: Hartford Casualty Insurance Company 29424 1306185 25124 SPRINGFfELD COURT, SUITE 200 VALENCIA CA 91355 The Doctors Co, An Interlns Exchange INSURER B: a 34495 I"SURER C : Liberty Mutual Fire Insurance Company 23035 ENSURER D: INSURER E: COVERAGES ~ THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSI IRFRIS7 GIITH(1RI7Fn RFPRFSFNTGTIVF (]R PR(1f)I Ir'FR 6N^ TNF CFRTIFICATF Hnl nFR. 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 PAfD CLAIMS. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE {MMJDDIYY) DATE (MM/DD1YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1 aoo oao A X COMMERCIAL GENERAL LIABILITY 6lUENHY9296 9/1/2009 9/1/2010 DAMAGE TO RENTED PREMISES Ea occurence $ 3oo,oao CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ 1 a aaa PERSONAL BADV INJURY $ 1 aaa aaa GENERAL AGGREGATE $ 3 aaa aaa GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPlOP AGG $ 3 aaa aaa PRD- POUCY JECT X LOC C AUTOMOBILE LIABILITY AS2-691-450294-029 9/1/2009 9/1/2010 COMBINED SINGLE LIMIT $ >, aaa aaa x ANY AUTD AP ROV A -TO F RM cEa accident) , , ALL OWNEG AUTOS ~ ~ BODILY WJURY $ ~UYXXXXX SCHEDULED AUTOS (Per person) X HIRED AUTOS i k BODILY INJURY $ XXXXXXX X NON-OWNED AUTOS JOS a ph Stra (Per accident) AsaiStan City Attor Cy PROPERTY DAMAGE (Per accident) $ XXXXXXX GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ XXXXX XX NOT APPLICABLE ANY AUTO OTHER THAN EA ACC $ XXXXXXX AUTO ONLY: qGG $ XXXXXXX EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ XXX,YXXX OCCUR ^ CIAIMS MADE AGGREGATE $ XXXXXXX UMBRELLA NOT APPLICABLE $ XXXXXXX DEDUCTIBLE FORM $ XXXXXXX RETENTION $ $ XXXXXXX G WORKERS COMPENSATION AND WA2-69D-450294-019 9/1/2009 9/1/2010 X way L MITS ~ R EMPLOYERS' LIABILITY i aaa aaa ANY PROPRIETORiPAR7NER/EXECUTIVE E.L. EACH ACGDENT , , $ OFFICEWMEMBER FJ(CLUDED7 E.L. DISEASE - EA EMPLOYEE $ i,aaa,aaa If yes, tleaaae undo SPECIAL PRONSIONS belay IVO E. L. DISEASE-POLICY LIMIT $ i,aaa,aaa B OTHER 0069727 5/1/2009 5/1/2010 $1000,000 Per Claim Medical Professional Cl i M d i i i $3,000,000 Annual Aggregate Deductible: $(00 000 Per Claim ms a e L ab l ty: a , DESCRIPTION OF OPERA710NS1LOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS NOTE: MEDICAL PROFESSIONAL LIABILITY GROUP RETROACTIVE DATE 10/1/95. ADDITIONAL INSURED IN FAVOR OF CITY OF SANTA ANA ((ON ALL POLICIES EXCEPT WORKERS' COMPENSATION/EL AND THE MEDICAL PROFESSIONAL LIABILITY) WHERE AND TO THE EXTENT REQUIRED BY WRITTEN CONTRACT. CERTIFICATE HOLDER CANGE4L~ TION ~ 04771 ~ 2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE D(PIRATION CITY OF SANTA ANA DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 34 DAYS WRITTEN 20 CIVIC CENTER PLAZA NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL SANTA ANA CA 82701 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR V •" ~'~ -- T REPRESHWTATIVES. AUTHORIZED REPRESENTATIV ~~ ACORD 25 (2Q01/08) For questlona rcgartfing this ceRificate, contact the number Ilated in the'Producef section above. ®ACORD CORPORATEON 9988