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<br /> <br />L ABIL TYIQINSURANCERCQMPAHIY <br />A TOC Company <br />1888 Century Park E, Ste. 850, Los Ancfefes, California <br />CERTIFICATE OF INSURANCE <br />is is to certify that the Policy of Insurance listed betov? 17as been issued fo the Insured <br />[withstanding any requirement, term or condition or any wntract or other document wn <br />y be issued or may pertain, the Insurance afforded by the Policy described herein la s <br />d conditions of such Policy. <br />NAME AND ADDRESS OF <br />NAMED INSURED: <br />Luis E. Rivera, M.D. ? - <br />800 North Tustin Avenue, Suite A <br />Santa Ana, CA 92705 <br />800137-? 737 <br />Th Named and Is In force al this lime. <br />No 'th respect to wltieh this Certificate <br />ma ubJecf io all the terms, exclusions <br />an <br />ADDITIONAL INSUREDS: <br />(shared limits of coverage) <br />East Edinger Industrial UC 8 <br />Tustin-Irvine Medical Oroup, Inc. <br />RETROACTI V E <br />DATE: <br />02!02/2009 <br />SPECIALTY: <br />POLICY NUMBER: <br />P93605.13 <br />LIMITS OF LIABILITY: <br />$1,000,000.00 per claim <br />$3,000,000.00 aggregate <br />TYPE OF INSURANCE: M <br />NAME AND ADDRESS OF <br />CERTIFICATE FiOLOER: <br />Coastal Community Hospital <br />2707 S. Oristol Stree! <br />Santa Ana. CA 82704 <br />Attn: Medlca151eH Office <br />Date lasued: August 30, 2012 <br />POLICY EFFECTIVE DATE: POLICY EXPIRATION DATE: <br />September 1, 2012 _ ` <br />72 <br />0 <br />?Yl September 1, 2013 <br />: <br />1 e. m. slander1LtP <br />TV 72:01 e. m. slarWard lima <br />RV ?` AS POLICY RETROACTIVE DATE: <br /> September 1, 2005 <br />gepb Stt pttoCpey 72:01 e.m. standard lima <br />So <br />(?rlty <br /> <br />PROFESSIONAL LIAl3tLITY ? - <br /> NAME AND ADDRESS OF BROKER: <br /> The Doctors' Company insurance Services. LLC. <br /> 185 Greenwood Road <br /> Napa. CA 84b58-0800 <br />Aulhorizod Representative: __!,_?E `^?? ??rrU-?'"""" °-? ?__ <br />SPECIALTY: <br />Omura! Surgery <br /> <br />? ? <br />w <br />i