WELDY, SCOTT DR. a/k/a SERRANO ANIMAL & BIRD HOSPITAL 5C - 2012

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SERAN-1 OP ID: LMO ,acoRL7' CERTIFICATE OF LIABILITY INSURANCE DATE(M07/11/121/121YY) 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 CONTACT NAME: PHONE AX (A/C. No A/ EXt : C No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # Kathy R. Noe, CPCU, ARM -VP INSURER A:Fireman's Fund Insurance Co. INSURED Serrano Animal & Bird Hospital Scott H. Weldy, DVM 21771 Lake Forest Drive #111 INSURERS: INSURER C : INSURER D : Lake Forest, CA 92630 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBFR- 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 DD UBR POLICY NUMBER MMIDDY/YEYYY MM/DDT LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FxI OCCUR X AZC80876144 07/01/12 07/01/13 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: [Ei2DUCTS-COMP/OPAGG $ 1,000,00 POLICY PROT- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ AIANY AUTO AZC80876144 07/01/12 07/01/13 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident ( ) $ HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ 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 EMPLOYE $ 1,000,00 (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is reci6 ) t - i.J l;. -I �'++s `. i ' N i 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 - CC `j y., ty Attorracy W.APO CLLA I IUIV 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 nynla raservea.V , - ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ��