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Client#: 37166
<br />SXCHEALT
<br />ACORDT. CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM/DD/YYYY)
<br />5/03/2012
<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 />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />CONTACT
<br />NAME: Craig Johnson
<br />Chicago Commercial Lines
<br />PHONE 312 922-5000 FAX 866-594-4578
<br />A/C No Ext : A/C, No
<br />HUB International Midwest Limited
<br />ADDRIESS: craig.johnson@hubinternational.com
<br />55 E. Jackson Blvd.
<br />PRODUCER
<br />Chicago, IL 60604
<br />CUSTOMER ID#:
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />INSURED
<br />INSURER A: Hartford Fire Insurance Co.
<br />19682
<br />Health Solutions Inc.
<br />INSURER B: Steadfast Insurance Co.
<br />26387
<br />HealSXC
<br />LLC
<br />INSURER C Hartford Underwriters Ins. Co.
<br />30104
<br />300 ap
<br />8300 E. Maplewood Ave, Suite 100
<br />Greenwood Village, CO 80111
<br />INSURER D :
<br />INSURER E :
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<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 ANY 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
<br />LTR
<br />I
<br />I TYPE OF INSURANCE
<br />DID
<br />NSR
<br />UBR
<br />D POLICY NUMBER
<br />POLICY)
<br />MM/DOIYYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />GENERAL LIABILITY.
<br />�.,' 83UUNKV7086
<br />6/30/2011
<br />06/30/2012
<br />EACH OCCURRENCE
<br />$1,000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE CI'' OCCUR
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$1,000,000
<br />MED EXP (Any one person)
<br />$10,000
<br />PERSONAL &ADV INJURY
<br />$1,000,000
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGG
<br />$2,000,000
<br />POLICY F PRO X LOC
<br />$
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />83UUNKV7086
<br />6/30/2011
<br />06/30/201
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />$
<br />ANY AUTO
<br />ALL OWNED AUTOS
<br />° tlF a
<br />;.w.I
<br />BODILY INJURY (Per person)
<br />$1,000,000
<br />BODILY INJURY (Per accident)
<br />$1,000,000
<br />SCHEDULED AUTOS
<br />HIRED AUTOS
<br />�
<br />X
<br />PROPERTY DAMAGE
<br />(Per accident)
<br />$
<br />X
<br />$
<br />NON -OWNED AUTOS
<br />B
<br />X
<br />UMBRELLA LIAB
<br />HX
<br />OCCUR
<br />I
<br />HPC926750201
<br />6/30/2011
<br />06130/2012
<br />EACH OCCURRENCE
<br />s20,000,OOO
<br />AGGREGATE
<br />s20,000,OOO
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DEDUCTIBLE
<br />$
<br />X
<br />$
<br />RETENTION $ 50,000
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED? ❑
<br />N/A
<br />83WEJ18512
<br />6/30/2011
<br />06/30/201
<br />X TWC Y LIMIT OTH-
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />$1,000,000
<br />B
<br />Pharmacy
<br />HPC948777800
<br />6/30/2011 �06/30/20112$1,000,000
<br />Each Claim
<br />Prof. Liability I
<br />,
<br />$3,000,000 Aggregate
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />The City of Santa Ana, its officers, employees, agents and representatives are included as additional
<br />insureds under Commercial General Liability, on a primary and non-contributory basis, when agreed in a
<br />(See Attached Descriptions)
<br />City of Santa Ana Parks
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Recreation & Community Services
<br />y
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Agency
<br />Attn: Silvia Cuevas
<br />AUTHORIZED REPRESENTATIVE
<br />26 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />®1988-2009 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2009/09) 1 of 2 The ACORD name and logo are registered marks of ACORD
<br />#S555939/M555839 KB02
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