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ACORO CERTIFICATE OF LIABILITY INSURANCE 7'_ /dd/yy) <br /> 71/2010 <br />Producer THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. <br />Wood Gutmann & Bogart Insurance Brokers THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE <br />15901 Red Hill Ave <br />Suite 100 COVERAGE AFFORDED BY THE POLICIES BELOW. <br />., <br />Tustin <br />CA 92780 INSURERS AFFORDING COVERAGE <br />, INSURER Hartford Casualty Insurance Company <br /> A <br />License No. 0679263 714 505.7000 INSURER American Casualty Company of <br />www.wgbib.com 714 573.1770 Reading, PA <br />Insured INSURER <br />Pulmonary Consultants & Primary Care <br />Physicians Medical Group, Inc. INSURER <br />1310 W. Stewart Dr ive #410 D <br />Orange CA 92868 <br /> INSURER <br />L,onto- i 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. AGGR EGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> POLICY POLICY <br />INSR EFFECTIVE EXPIRATION <br />LTR TYPE OF INSURANCE POLICY NUMBER DATE DATE LIMITS <br /> MM/DD/YY MM/DD/YY <br />A GENERAL LIABILITY 72SBAIA4429 5/1/2010 5/1/2011 EACH OCCURRENCE $ 2,000,000 <br /> COMMERCIAL GENERAL LIAB FIRE DAMAGE (An one fire) $ 300,000 <br /> CLAIMS MADE OCCUR MED EXP (An one person) $ 10,000 <br /> PERSONAL & ADV INJURY $ 2 <br />000 <br />000 <br /> GENERAL AGGREGATE , <br />, <br />$ 4 <br />000 <br />000 <br /> GEN'L AGG LIMIT APPLIES PER PRODUCTS-COMP/OP AGG , <br />, <br />$ 4,000,000 <br /> POLICY PROJECT LOC $ <br />A A UTOMOBILE LIABILITY 72SBAIA4429 5/1/2010 5/1/2011 <br /> <br />ANY AUTO COMBINED SINGLE LIMIT <br />$ 2,000,000 <br /> ALL OWNED AUTOS BODILY INJURY <br /> SCHEDULED AUTOS (Per person) $ <br /> HIRED AUTOS BODILY INJURY <br /> NON-OWNED AUTOS (Per accident) $ <br /> PROPERTY DAMAGE <br /> (Per accident) $ <br /> GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ <br /> ANY AUTO OTHER THAN EA ACC $ <br /> AUTO ONLY: AGG $ <br /> EXCESS LIABILITY EACH OCCURRENCE $ <br /> OCCUR ? CLAIMS MADE AGGREGATE $ <br /> <br /> DEDUCTIBLE <br />$ <br /> RETENTION $ $ <br />B WORKERS' COMPENSATION & <br />' 4012325181 10/1/2009 10/1/2010 STATUTORY LIMIT THER <br /> EMPLOYERS <br />LIABILITY EL EACH ACCIDENT $ 1,000,000 <br /> EL DISEASE - EA EMPLOYEE $ 1,000,000 <br /> EL DISEASE - POLICY LIMIT $ 1,000,000 <br /> <br />DESCRIPTION OF OPERATIONS LOCATIO EHICLES CLUSIONS ADDED BY EN RSEMENT S CIAL PR ISIONS <br /> A.PP OVET TO FORM <br />R? <br /> ? <br />City of Santa Ana is named as additional insured under the GL policy per the attached SS 00 08 04 05. <br /> Joseph Straka <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 /> 30' DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE <br />City of Santa Ana 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 Non-Payment of Premium. <br /> AUTHORIZED <br /> REPRESENTATIVE <br /> 7?--- <br />, s <br />? <br /> Blane Peters 7 <br />/ u <br />W <br />ACORD 25-S (7/97) © ACORD CORPORATION 1988 <br />CERT NO.: 7749568 Angelina Garcia 7/1/2010 3:06:15 PM Page 1 of 5