CARE AMBULANCE SERVICES INC. (2012-196)

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A,- ow '4 - lq4a Aim °® CERTIFICATE OF LIABILITY INSURANCE Page 1 of 2 10/i%a20 ' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND 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 CONTACT Willie of New York, Inc. c/o 26 Centur Blvd PHONE 877-94 5-7378 FAX 886-467-2378 . y P. O. Box 305191 E-MAIL gertificates@willir..com TH 37236-5191 INSURER(S)AFFORDING COVERAGE NAICif INSURERA: Arch specialty insurance Company 21199-002 INSURED INSURERB:Liberty Mutual Fire Insurance Company 23035-001 Cars Ambulance Service, Inc. 1517 Braden Court INSURERC:IF Skadeforsakrings AS F9367-001 Orange, CA 92868 INSURER p: Liberty insurance corporation 42404-001 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 18767380 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. II TO TYPE OF INSURANCE D SUB POLICY NUMBER POLICY EFF puffian= POLICY EXP LIMITS A GENERAL LIABILITY Y FLPDO46376-01 10/1/2012 10/1/2013 EACH OCCURRENCE $ 5. 000, D00 COMMERCIAL GENERAL LIABILITY DPREA EI ER' uDence $ 300,D00 CWMS-MADEa OCCUR MEDEXP An one rson $ 51000 PERSONAL&ADV INJURY S 5,000,000 GENERALAGGREGATE S 51000,000 GENLAGGREGATE LIMIT APPLIES PER." PRODUCTS -COMPIOPAGG S 5,000,000 POLICY PRO- LOG $ B AUTOMOBILE LIABILITY Y AS2-631-510005-022 0/1/2012 10/1/2013 51)s?!N ,tsINGLELIMIT $ 5,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALLOWNED AUTOS SCHEDJLED AUTOS BODILY INJJRY(Perecddent) $ HIRED AUTOS P NONOWNIED AUTOS AMAGE Per ec,.d. $ E C UMBRELLA LIAB X OCCUR LP0000025622-12 0/1/2012 10/1/2013 EACH OCCURRENCE S X EXCESS LIAR CUUMS-MADE AGGREGATE $ 10,000,000 DED RETENIION$ $ D WORKERS COMPENSATION Y WA7-63D-510005-012 0/1/2012 10/1/2013 Z AND EMPLOYERS' LIABILITY ANY PROPRIETORrPARTNERIEXECUTIVEYO NIA E.L. EACH ACCIDENT $ 1,000,000 ?O1FaFICEWMEMBE1REXCLUDED? d N ELOtSFASE-FA EMPLOYEE $ 1,000,000 0.yes eealbe ntler DESCRIPTIONOFOPERATIONSbelow E.LDISEASE -POLICYLtMT $ 1,000,000 A Professional Liab F 10/1/2012 10/1/2013 Each Medical Incident $5,000,000 Aggregate $5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach Acord 101, Addko" Remarks Sctwduk, ff mm span Is r"Wmd) APPROVED AS TO FORM CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTOO D ESENT City of Santa Ana and OCFA Coll:3901342 Tpl:1522613 Cert:18767380 ® 88-2010ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered mark of ACORD KR'C,"'O' r-or0610 X 5Z?1