CORRECTIONAL MANAGED CARE MEDICAL CORPORATION (CMCMC) 5c - 2010

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AL;UKLJ CERTIFICATE OF LIABILITY INSURANCE oTE(M / DN 0) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endomement(s). PRODUCER Colonial Western Insurance Agency 26691 Plaza Drive, Suite 220 Mission Viejo, CA 92691 TM NAME: PHONE Ett: (949)305 -6161 F,,"xc No: (949)305 -6166 E-MAIL ADDRESS: WVD POLICY NUMBER CUSTOMER I INSURE S) AFFORDING COVERAGE NAIC al INSURED Correctional Managed Care Medical Corporation 4211 E. La Palma Ave. Anaheim, CA 92807 INSURERA: Landmark American Insurance Comp ny INSURER B: Travelers Insurance Company LHC85-4 84 INSURER C: Everest Insurance Company 08/01/2011 INSURER D: $ 1'000'0001 INSURERE: - - -- _ INSURER F: COVE RAGES CERTIFICATE NUMBER- City of tanta Ana oevrernu uuaan n. THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN LTR TYPE OF INSURANCE L MR WVD POLICY NUMBER M E� M LIMITS GENERAL LIABILITY LHC85-4 84 08101/2010 08/01/2011 EACH OCCURRENCE $ 1'000'0001 X COMMERCIAL GENERAL LIABILITY C' PREMISES (Ea oxurrenoe) $ S0, OO X CLAIMS -MADE OCCUR A MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,00( GENERAL AGGREGATE $ 3,000,00( GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 11 OOO , OO POLICY ACT LOC AUTOMOBILE LIABILITY 6809447H706 02RW2010 02/04/2011 COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) 1, 000, OO ALL OWNED AUTOS BODILY INJURY (Per person) $ B SCHEDULED AUTOS A ROVE S E O NT - BODILY INJURY (Pet aoo derd) $ X HIRED AUTOS PROPERTY DAMAGE (Per accident) $ X NON -OWNED AUTOS $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS.UAB CLAIMS-MADE AGGREGATE $_ DEDUCTIBLE $ RETENTION $ $ WORKERSCOMPENBATION YIN CA200109SMO 07/01/2010 07/01/2011 AND EMPLOYERS' UAMLnY X WCSTATT ER OR C �ICERIMEM EXCL� UDEECUTIVE❑ N/A E.L. EACH ACCIDENT $ 11000,00 (Mandatory in NH) K desaibe under DESCRIPTION E.L. DISEASE - EA EMPLOYEES 1,000,00 OF OPERATIONS below ro essiona Liability E.L. DISEASE- POLICY LIMIT $ 19000900 A LHC81448 08/01/2010 08/01/2011 anaged Care E&O Liab. Prof Liability: Slmil /S3mil LHC81448 08/01/2010 08/01/2011 Managed Care E&O: Slmil /S3mil DESCRIPTION OF OPERATIONS / LOCA7K I VEHICLES (Attach ACORD 101 Adt tional Remarks Schedule, more splice is required) 0 Days notice of cancellation, 10 days for non - payment OT premium. rtificate Holder is an Additional Insured for general liability and professional liability per [nodorsements (Additional Insured - Designated Person or Organization & Waiver of Transfer Rights of Recovery Against Others To Us) attached. City of Santa Ana 62 Civic Center Plaza Santa Ana, CA 92702 I IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. REPRESENTATIVE W) T -zvva ACORD CORPORATION. All rights reserved. ACORD 26 (2009/09) The ACORD name and logo are registbead4lifiarks of ACORD