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<br />CERTIFICATE OF LIABILIT INSURANCE
<br />DAFE(MMIDD/YYYY)
<br />I
<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 staterrlent on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s),
<br />PRODUCER
<br />Aon Risk Services Northeast, Inc.
<br />New York NY Office
<br />CONTACT
<br />NAME:
<br />(IAION .Exile ($tiff) 2fi3 -7122 IBC. N ©.): (fii}' ©) 363-0 .I.pS; ° °._
<br />E -MAIL
<br />ADDRESS:
<br />199 Water Street
<br />New York NY 10038 -3551 USA
<br />INSURER(S) AFFORDING COVERAGE NAtC 7
<br />$2,000,000
<br />INSURED
<br />INSURER A: Lib? `ty M.,.ual Fire. Ins CO. 230335
<br />Care Ambulance Service, Inc.
<br />ENSURER B; Liberty Insurance Corporation
<br />151,7 W. Braden Court
<br />Orange CA 92868 USA
<br />INSURER G: Lloyd's Syndicate NO. 2623 AA1128b23
<br />'INSURER D: Steadfast insurance Company 26387
<br />DAMAG G,HN
<br />�PREiv1SE5 'Ea accurr�nceY
<br />INSURER E:
<br />INSURER F:
<br />MED L'xP (A.y on. person;)
<br />COVERAGES CERTIFICATE NUMBER: 570055353066 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. Limits shown are as requested
<br />LTR TYPE OF INSURANCE PNSO WVD POLICY NUMBER fMMfOD1YYYYI IMWDDIYYYY LIMITS
<br />O
<br />X
<br />COMMERCIAL GENERAL. LIABILITY
<br />w14.3R7140201
<br />1.0/01/201.4
<br />EACH OCCURRENCE
<br />$2,000,000
<br />�-""
<br />CLAIM F, -MADE I X I OCCUR
<br />�.�.7
<br />DAMAG G,HN
<br />�PREiv1SE5 'Ea accurr�nceY
<br />�� 3100,000
<br />X
<br />MED L'xP (A.y on. person;)
<br />S5,000
<br />FsoduoCa - -cWms Made
<br />PERSONAL &ADV INJURY
<br />Incl.ude.d
<br />GENERAL AGGREGATE
<br />$2,000,0
<br />GEN'L AGGREGATE LIMIT APPLIES PER..
<br />X. POLICY E] PRO- F LtiC
<br />L......�.1 JECT
<br />PRODUc: s comproP I' +.GG
<br />$2,000,000 ,
<br />OTHER.
<br />A :
<br />AUTOMOBILE LIABILITY
<br />'�, AS2 -6:31- 510005 -024
<br />10/01/21)14.10/0112015
<br />COM,IEINEDSINGLEUM IT
<br />''.. Ea accident'
<br />'S2,000,000
<br />BODILY INJURY ( Per person)
<br />X ANY AUTO
<br />BODILY INJURY (Per accident)
<br />ALL OWNED SCHEDULED
<br />"OS
<br />AUTOS AUl
<br />°-
<br />PROPERTY DAMAGE
<br />HIREDAUTOS NON-OWNED
<br />SPer accident)
<br />AUTOS
<br />D'
<br />x
<br />UMBRELLA LIAB
<br />ccc,DR
<br />U+B541477001
<br />t/O1204
<br />0101 2:015
<br />EACH OCCURRENCE
<br />S10,005 _0
<br />AGGREGATE
<br />sila,000,000...
<br />EXCESS I
<br />CLF1M5 M
<br />DED RETENTION
<br />B
<br />EFRSATD1o�A4JD
<br />WA7G 3r 510005(714
<br />1U, "01/2014
<br />10/01/2015
<br />I "ER r
<br />EMPLOYERS'
<br />EMP OYERS' LIABILITY
<br />E EACH ACCIDENT
<br />ST., (70'O, L7
<br />RTTNER f EXECUTIVF YtiN,,
<br />(Mandatary in NH)
<br />...,NIA
<br />E, L. DISEASE -EA EMP_OYEE
<br />51,000,000
<br />Ir yes describe under
<br />DESCRIP°If)N OF OPERATIONS below
<br />i
<br />E.L. DISEkSE- Pry " "iLOr.;1' LI<ti11T
<br />31 , 00-076 _00
<br />c
<br />Misc Med Prof
<br />W143B7140201
<br />ArJ /01 ZU14
<br />10/01/2015
<br />Ea. Medical lnciden
<br />32,000 ,000
<br />Aggregate Litnit
<br />52,000,000
<br />(space
<br />A
<br />52,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS i VEHICLES (ACORD 191,. Addttsonal Remarks Schedule, rnay be aYlached it more Is required)
<br />Tile City of Santa Ana an'.€I CCFA, and Their respective officers, officials, eriployees, represent,atl ve. and volunteers are included
<br />as as Additional insured per Conti-act ar- AgreerrI with the City of Santa Ana in accordance with the policy provisions of the
<br />General Liability and AUtmobile Liability poliO eS,
<br />The Policies evidenced herein are Primary and Non - Contributory to other inSNranoe available to an Additional Insured, but only
<br />in accordance the policy's pro0 S5 onS,
<br />D,vitl
<br />wa gati...on 1S granted in favor of The city o'f Santa Ana add OCFA, their respective of "flcers, Officials, eloployees.
<br />repYecentatives and volunteers in accordance torith the PoliiCy provislpn5 of the workers COIM1pensation policy'.
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
<br />POLICY PROVISIONS.
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<br />The City of Santa Ana and OCFA AUTHORIZED REPRESENTATIVE
<br />f=inance & Management Services Agency
<br />20 Civic Center Plaza
<br />PO Box 1988
<br />Sanata Ana CA 92702 USA
<br />CC1988 -21 14 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD M yVr�41 l i
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<br />,rJUde, 0? . ,
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