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��..., WeIIDyneRX A-2007-278-02 REVIEWED BY ` �1 ''f ,.__ EUNICE HEREDIA (PG 1 OF 1) <br />ACC>RL'r CERTIFICATE OF LIABILITY INSURANCE17/23/2015D <br />ATE /DD/Y <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 />One, Inc. dba Peak 360 <br />1600 Emerson St. <br />Denver CO 80218 <br />CONTACT Gary Friedman, CPCU MSIS RPLU ARM, AAINAME: <br />PHONE (303)534-7325 FAX C Not: (303)623-7325 <br />E-MAIL friedman@ eak360.com <br />ADDRESS:g P <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSURERAArch Specialty Insurance <br />INSURED <br />WellDyne Holding Corporation, WellDyne, Inc.; <br />WellDyneRX, Inc.; Wellsystems <br />500 Eagles Landing Drive <br />Lakeland FL 33810 <br />INSURER B :Continental Insurance <br />INSURERC:CNA Insurance Company <br />INSURER D:Hartford <br />INSURER E: <br />INSURERF: <br />COVERAGES CERTIFICATE NUMBER:CL14121001363 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 LTR <br />TYPE OF INSURANCE <br />ADDL <br />SUER <br />POLICY NUMBER <br />MMIDDY� <br />POLICY <br />DDIYYYY <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1,000,000 <br />X COMMERCIAL GENERAL LIABILITY <br />DAMAGE TO RENTED <br />PREMISES Ea occurrence <br />$ 100,000 <br />A <br />CLAIMS -MADE a OCCUR <br />X <br />LP0052651-00 <br />12/7/2014 <br />12/7/2015 <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 />PRODUCTS - COMP/OP AGG <br />$ 3,000,000 <br />X POLICY PRO- LOC <br />$ <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident <br />1,000,000 <br />X <br />BODILY INJURY (Per person) <br />$ <br />$ <br />ANY AUTO <br />BODILY INJURY (Per accident) <br />$ <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />40269115883 <br />12/7/2014 <br />12/7/2015 <br />NON -OWNED <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />HIRED AUTOS AUTOS <br />$ <br />X <br />I UMBRELLA LIAB <br />X <br />OCCUR <br />EACH OCCURRENCE <br />$ 2,000,000 <br />AGGREGATE <br />$ 2,000,000 <br />A <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED X RETENTION 10,00C <br />$ <br />FLP0052651-00 <br />12/7/2014 <br />12/7/2015 <br />C <br />WORKERS COMPENSATION <br />X WC STATU- OTH- <br />AND EMPLOYERS' LIABILITY YIN <br />E.L. EACH ACCIDENT <br />- <br />$ 1 000 000 <br />, <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />[NE]NIA-• <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH) <br />C5093687712 <br />6/1/2015 <br />6/1/2016 <br />E.L. DISEASE - EA EMPLOYE <br />$ 1,000,000 <br />If yes, describe under <br />r <br />E.L. DISEASE - POLICY LIMIT <br />$ 11000,000 <br />DESCRIPTION OF OPERATIONS below <br />A <br />PROFESSIONAL LIABILITY <br />LP0052651-00 <br />12/7/2014 <br />12/7/2015 <br />OCCURRENCE/AGGREGATE $lM / $3 <br />D <br />TPA E&O LIABILITY <br />0OPGO257328 <br />12/7/2014 <br />12/7/2015 <br />OCCURRENCE/AGGREGATE $1M / $1 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />Certificate Holder is an additional insured under the General Liability policy in accordance with all the <br />terms, conditions, and limitations of the policy and then only for liability caused by the negligent acts <br />of the named insured and then only as their interest may appear by way of written contract. <br />ckindig@santa-ana.org <br />CITY OF SANTA ANA <br />CHRISTY KINDIG <br />20 CIVIC CENTER PLAZA <br />SANTA ANA, CA 92701 <br />L;ANL;CLLA I IUN <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 />AUTHORIZED REPRESENTATIVE <br />Gary Friedman/GARY .. "r cr; <br />ACORD 25 (2010/05) <br />INS025 mmnns) ni <br />© 1988-2010 ACORD CORPORATION. All rights reserved. <br />Tha Ar'.r1Rr1 nmmn nnrl Innn nra rnnicfnrarl mnrkc of Ar:rlpn <br />