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U DATE (MM/DD/YYYY) <br />fa?ORO CERTIFICATE OF LIABILITY INSURANCE D4/05/2D„ <br />?? <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 />`FLOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />PRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the eertiFcate holder is an ADDITIONAL INSURED, the policy(ies) must ba endorsed. IT SUBROGATION IS WAIVED, subject to <br />the t8rms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not oonfer rights to the <br />certificate holder in lieu of such endorsement(s). <br />CONTACT <br />PRODUCER N ME- <br />Marsh Risk & Insurance Services PHONE FAX <br />4695 MacArthur Court, Suite 700 ac No <br />(949) 399-5800 ? aooae ss? <br />License #0437153 PRODUCER <br />Newport Beach, CA 92660 _ _ Y <br />INSURED <br />Western Medical Center <br />'-:agra od Healthcare ;'? ? r.^ys.::c. <br />1301 North Tusfin Avenue <br />Santa Ana, CA 92705 <br />INSURER A :Columbia Casualty Col <br />INSURER B : Lexington Insurance C? <br />,uclloce r -Philadelphia Insurance <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 ANV 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 ADDL 5 B POLICY EFF POLICY EXP LIMITS <br />LTR TYPE OF INSURANCE POLICY NUMBER MMIDD/YW MIDD Y <br />A GENERAL LIABILITY HMU 2097477891-4 04/01/2011 04/01/2012 EACH OCCURRENCE $ <br /> N <br />ED <br />O <br />A <br />A <br /> X COMMERCIAL GENERAL LIABILITY C <br />e <br />SES <br />Ea o <br />P <br />E $ <br /> CLAIMS-MADE ? OCCUR MED EXP (An one arson $ _ <br /> <br /> X Healthcare CLAIMS MAQ?__ <br />_C PERSONAL 6 ADV INJURY $ <br /> OV <br />?¦?( fY? <br /> Professional Liab 3-6-OS GENERAL AGGREGATE $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ SEE BELOW <br /> POLICY PRO LOC $ <br /> <br />C <br />AUT <br />OMOBILE LIABILITY PHPK702938 /2 D4/01/2012 colnewED SINGLE LIMIT $ 1,000,000 <br /> (Ea accitlenQ <br /> X C?' ? <br />M 1 HWAITE <br /> ANY AUTO . BODILY INJURY (Per person) S <br /> An <br />eft <br />..a <br />ue ?Y <br /> ALL OWNED AUTOS <br />y <br />s <br />p <br />BODILY INJURY (Per accident) <br />$ <br /> SCHEDULED AUTOS <br />PROPERTY DAMAGE <br /> <br />X <br /> <br />HIRED AUTOS <br />(Per acdden[) $ <br /> X NON-OWNED AUTOS $ <br /> <br />A X UMBRELLA uAB X <br />OCCUR HMU 2D97477891-4 04/0 V2011 04/01/2012 EACH OCCURRENCE $ 10,000,000 <br /> 000 <br />000/$10 <br />000 <br />000 <br />excess of $2 <br />000 <br />10 <br />000 <br /> EXCESS LIAB X CLAIMS-MADE , <br />, <br />. <br />, AGGREGATE , <br />, <br />g <br /> SIR Professional Liability 8 GL <br />L <br />tt <br />S <br /> DEDUCTIBLE SIR ee <br />e <br />$ <br /> X RETRO DATE--.3-8-OS $ <br /> RETENTION $ <br /> WORKERS COMPENSATION WC STAT U- OTH- <br /> AND EMPLOYERS' LUi BI LITY <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ _ <br /> ? <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory In NH) N / A <br />E.L. DISEASE - EA EMPLOYE <br />$ <br /> If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />EL. DISEASE -POLICY LIMIT <br />$ <br />B EXCESS UMBRELLA 6796942 04/01/2011 04/01/2012 Each Occurrence 15,000,000 <br /> RETRO 3-&05 Aggregate 15,000,000 <br />DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (Attach ACORD 101, Atltlhlonal Remartts Schetlula, If more space Is raqulretl) <br />THE CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS AND REPRESENTATIVES ARE INCLUDED AS ADDITIONAL INSUREDS WHERE REQUIRED BY WRITTEN CONTRACT. <br /> <br /> S HOULO ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />CLERK OF THE CITY COU NCII- THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br />OITY OF SANTA ANA <br />R PLAZA (M-30) <br />ZO CIVIC CEN TF <br />. <br />PO BOX 1988 AUTHORIZED REPRESENTATIVE <br />SANTA ANA, CA 92702-1988 of Marsh Rlsk a Insurance 5ervlcas <br /> John Graef ?- <br />CJ 19823-ZOUY AGVKV GVKYVKAI Ivry. Nu ngno re:oar Yru. <br />ACORD 26 (2009109) The ACORD name and logo are registered marks of ACORD