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ACORD CERTIFICATE OF LIABILITY INSURANCE ° 1/17' 2012' <br />�, 01 /17 /zolz <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: N the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. ff SUBROGATION IS WAIVED, subject to <br />the terns 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 endoreement(s). <br />PRODUCER <br />NAME: <br />Colonial Western Insurance Agency P N (949)305 -6161 No ;(949)305 -6166 <br />26691 Plaza Drive, Suite 220 ADDRESS: <br />Mission Viejo, CA 92691 INSURER(S) AFFORDING COVERAGE NNC 4 <br />P43URERA: Arch Specialty Insurance Company <br />INSURED Correctional Managed Care Medical Corporation INSURERS: Travelers Insurance Company <br />4211 E. La Palma Ave. INSURER C: Everest Insurance Company <br />Anaheim, CA 92807 INSURER D: <br />INSURER E : <br />INSURER F: <br />r_nvFUenFC I'FRT,FIr_ATF MrrMRFR• city of Canta Ana REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME OVE FOR THE LILY 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 />LTR <br />TYPE OF INSURANCE <br />Yyyp <br />POLICY NUMBER <br />POLICY ffl; <br />M <br />POLICY EXP <br />LIMITS <br />A <br />GENERAL LIABILITY <br />X COMMERCIAL GENERAL LL40UTY <br />X CLAIMS -MADE F] OCCUR <br />FLP004S67 <br />08/01/2011 <br />08101/2012 <br />EACH OCCURRENCE <br />S 1100 1 00 <br />PREMISES Ea o=ffw e <br />$ 100,00 <br />MED EXP QVV are pamm) <br />t S , 000 <br />PERSONAL. a AM INJURY <br />$ 1,000,00 <br />GENERAL AGGREGATE <br />$ 3,000,00 <br />GEN'L AGGREGATE UMTAPPUESPER <br />71POLICY MT LOC <br />- COMP/OPAGG <br />$ 3,000,00 <br />-PRODUCTS <br />$ <br />B <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />OVtlNED SCHEDULED <br />NON-OWNED <br />X �NO <br />HIRED AUTOS C <br />6809447H706 <br />02!0412012 <br />0210412013 <br />Eaaadde <br />$ 11000,00 <br />BODILY INJURY (Px peraan) <br />$ <br />BODILYIWURY(Poraccident) <br />S <br />Pw� <br />$ <br />a <br />UMMEU A LA13 <br />EXCESS LIAR <br />OCCUR <br />CLAIMS -MADE <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />DEO I I RERENT1oN s <br />$ <br />C <br />WORIMRSODYPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANFICER R IX �� <br />(Mandatary In NH) <br />If yes describe uMer <br />DESCRIPTION OF OPERATIONS baaw <br />NIA <br />CA200109SS11 <br />07101/2011 <br />07/01/2012 <br />X TORY LIMT8 []2 <br />E.L. EACH ACCIDENT <br />$ 1,000,00( <br />E.L. DISEASE - EA EMPLOYEE <br />S 1,000,00( <br />E.L. DISEASE - POLICY LIMIT <br />$ 1,000,00 <br />A <br />ro essional Lie , Tty <br />naged Care Ed10 Liab. <br />FLP004S679 <br />FLP004S67 <br />08/01/2011 <br />08/01/2011 <br />08101 /2012 <br />0810112012 <br />Prof Liability: $!mil /$3mil <br />Managed Care E&O: $lmil /$3mil <br />DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (Attach ACORD 101, AddIdona1 Remmha Salwdule K more space b rw Wred) <br />30 Days notice of cancellation, 10 days for non - payment of premium. Certificate Holder is Additional <br />insured for general & professional liability per endorsements (Additional Insured - Designated Person <br />or Organization & Waiver of Transfer of Rights of Recovery Against Others To Us) attached. <br />APPROVED AS TO FORM <br />-" TERESA L. <br />Anktaat City <br />City of Santa Ana <br />62 Civic Center Plaza <br />Santa Ana, CA 92702 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />REPRESENTATIVE <br />All rights <br />ACORD 26 (2010106) The ACORD name and logo are registered marks of ACORD <br />