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TUSTIN-IRVINE MEDICAL GROUP 1B-2011
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TUSTIN-IRVINE MEDICAL GROUP 1B-2011
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Last modified
1/3/2012 2:02:46 PM
Creation date
6/28/2011 10:28:03 AM
Metadata
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Template:
Contracts
Company Name
TUSTIN-IRVINE MEDICAL GROUP
Contract #
A-2011-131
Agency
FIRE
Council Approval Date
5/16/2011
Expiration Date
6/30/2012
Insurance Exp Date
8/12/2011
Destruction Year
2017
Notes
A-2009-110 A-2010-088
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.?c.vrciv GEIRTIFIGATE OF LIABILITY INSURANCE ovlD cs <br />06/07/.200111 TRU 10:17 FAX 0002/002 <br />?RD " CERTIFICATE OF`LIABILITY INSURANCE oPID cs <br />11 03/22/11 <br />THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLYANOCONFERS:NO RIGHTS UPON HE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY-OR NEGATIVELY AMEND,.EXTEND OR ALTER THE COVERAGE AFFORDED BYTHE POLICIES <br />BELOW. THIS CERTIFICATE OFaNSURA.NCE:DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING:IN5URER(S), AUTHORIZED <br />REPRESENTATIVE ORPRODUCER <br />, AND THE. CERTIFICATE HOLDER. _ <br />IMPUKJ at • e:CE S'a e o an ADDITIONAL I e'pD es mus e.en OM . It -SUBRO ; s et o <br />the terms and conditions of the policy, ce rtat0.; policies may require an endorsement. A statement on this:ceAlRcale does not confer rights to the <br />certificate holder in lieu of such endorsement(s)L <br />PRODUCER - <br />Rosmos :Insurance -- COCIA - <br />`urc: <br />License tOE93671. P E r- vAIC, fie: <br />1913 E. 17th Street, Suite 213 <br /> <br />.. <br />aoDnESSr. <br />Santa Ana CA 92705. cusTONEWs' AEEVI'2. <br />Phone;714-972-0950 Fax:714-541-5597 <br /> _-1NSURERIS)AFk. 1mcoVIRADE _.: NAIL+_. <br />INSURED -- NSURERA: Oregon . Xatual Ins. Co. 14907 <br />John G Alevizos D. 0.. Inc. <br />1530 °E- Edi <br />er Avenue #7 ,INSURERS': Oak River insurance CO <br />- 34630 <br />g <br />Santa Ana CA 92705 INSURERC: Pro aeatiw SnFUCance' C. way <br /> INSURERO: - <br /> INSURERS: <br /> 1PCUM RF :. . <br />L.uvr-HFactra GEN I IFIQATE NUMBER; - -- REVISION.. NUMBER: <br />THIS IS 70CERTIFY'THAT THE POLICIES OF INSURAN <br />INDICATEO NOTWIT.HSTMIDINOANY'REOUIRENENT, <br />CERTIFICATE MAY BE ISSUED 0RMAY PERTAIN; TFE I <br />EXCLUSIONS AND CCNDITIONS OF SUCH POLICIES. LI <br />LTR' TYPI:OF PIeURANCE NSW' CE -LISTEDBELOWHA IS - HE-INSURED '.'R. HE POLICY B IOD- <br />TERM OR'CONDITIONOFANY CONTRACT OR OTHER, DOCUMENT WITH RESPECT TO WHICH THIS <br />NSURANCE AFFORDED BY THE POLICIES DESCRIBEDHEREIN IS SUBJECT TO ALL THE TERMS; <br />MITS SHOWN IAAY HAVE9EEN REDUCED:BY PAID CLAIMS:.. <br />POLICY NLalER' (NMIDD(YYYI) (MMIDOAYYY) <br /> GENERAL LIABERY .ACT{ OCCJRRENCE. S2000000 <br />A R .NERCw GENERAL UABIUTY BSP704154 DS/12/10 IDS42/1. PREMISESEaecc. a 6100000 <br /> EAMSMADE ? O=R NED EXP (Arw aN Lamar) 6 5000. <br /> PERSONAL a ADV N. 1200000.0 <br /> R Non owned $2,000, 1 I GENERAL AGCREG1,- $4000000.- <br /> GEA'LAG6REGATEUMRAPPLIESPER: k PRODUCTS-COMP/D-AGG 540000D.D <br /> POLICY. JEG LOC j E <br />C AUI ONOB4E LMBEITY. <br />'.ANYM 0 0529 '- COMBINED'SNGLE LIMIT <br />(Eeecc dart{ $1000000 <br /> <br />ALL OmLO AITNS 3 <br />A$ e/0a/1. 3O0ILV'IN.LRYIPr 0erp6nl t <br /> Sl1EDUUF0 AIITCS y BoDLYrvA1RY hre dEertl s <br /> <br />HIRED.nU105 ? <br />?, j PROPERTY DAMAGE <br />(Pww feM) <br />_ S <br /> WNdydNED AUTOS S <br /> AL <br />.. t <br /> -UNDRELLAUAO ..OCCUR. . EACH. OCCLRRENCE t. <br /> EXCESS LAS I -LARASMdCf: ? <br />.AGGREGATE <br /> H DEDUCTIBLE _ _.. e <br /> RETENTION: S - 1 <br />B a YO <br />AND RRRLSCOYPENSATION. <br />ENPLOYBtS'UABElIV <br />N 2 OD 21717-YO - 10/A1Y10 10101/11- T08Y I' ER <br /> ANY <br />OW YI <br />PROPRIETORFAFTNERIDQNx/rIVE <br />CER/F mMR EXCLLDED7 ? <br />IA 'E L, EACM ACCIDENT ($1000000. <br /> (Modalary), NMI <br />a <br />' E.L. 'DISEASE EA EMPLOYEE $ 1000000 <br /> Ty aLdnc <br />r <br />WaFla <br />OES('RPTIONOFOPEPAnONS W., <br /> <br />=.L DISEASE' POLICY LMIT <br /> <br />s.lO:DODOO <br /> <br />ue <br />Proof oofVN of Ur ur CoververarLVLA1?Vna 1, venlclW IRrtaCII RGORD:Tm, PeaNeMl'RrmXUSUad?e, emen apau.h rpryirl0l <br />age <br />SHOULDANY OF TNEABOVE DESCRIBEDPOLICIES BECANCELLEDBEFORE <br />ALEV'L2,1 TICDIPRAMNDATET!!REOF,NOTICEriLLSEDEUVEAEDIN' <br />ACCORDANCE RDTN THEBOLICY PROVISIONS. <br />John G ASevizos. D.O. Inc. <br />800 N. Tustin Ave., Suite A <br />Santa Ana CA 92705 <br />L. <br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
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