WELDY, SCOTT DR. a/k/a SERRANO ANIMAL & BIRD HOSPITAL 5B - 2011

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SERAN-1 OP ID: LMO RCQR�' �,_„r..- CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY) 07/11/12 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 endorsement(s). PRODUCER 888-762-3143 Veterinary Ins. Services Co. CA License #OF64180 916-921-2266 1400 River Park Drive, #180 Sacramento, CA 95815 Kathy R. Noe, CPCU, ARM -VP CONTACT PHONE FAX AI No Ext : A/C No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:Fireman's Fund Insurance Co. INSURED Serrano Animal & Bird Hospital Scott H. Weldy, DVM 21771 Lake Forest Drive #111 Lake Forest, CA 92630 INSURERB: INSURERC: INSURER D: _ INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. ILTR TYPE OF INSURANCE ADDL U BR POLICY NUMBER MM/LDDY/YEYYY MM/DDY� LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X 1 COMMERCIAL GENERAL LIABILITY CLAIMS-MADE CI OCCUR X AZC80876144 07/01/12 07/01/13 PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 10,00 PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000,00 POLICY PROT- LOC $ A AUTOMOBILE LIABILITY ANY AUTO AZC80876144 07/01/12 07/01/13 COMBINED SINGLE LIMIT Ea accident $ 1'000 00 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y I N OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A WZP81004247 07/01/12 07/01/13 WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 E.L. DISEASE -POLICY LIMIT 1 $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is requi ) City of Santa Ana, its officers, agents and employees are included as % �- addtional insureds. Per Endorsement AB9189 0807 the insurance provided under this policy is primary 30 Days NOC/10 Days NOC for non-payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Parks, Rec. & Comm Svcs Agency Attn: Silvia Cuevas AUTHORIZED REPRESENTATIVE 26 Civic Center Plaza Kathy R. Noe, CPCU, ARM -VP Santa Ana, CA 92701 v,yoo-7-lu At.UKLJ I.u"uKA I IVN. An rlgnts reservea. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD ,,l