CORRECTIONAL MANAGED CARE MEDICAL CORPORATION (CMCMC) 5e - 2012

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CORRMAN -01 SEMORY I '4� °+ CERTIFICATE OF LIABILITY INSURANCE DA 8/3/2012 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()es) must be endorsed. If SUBROGATION IS WANED, 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 License # OE50896 Colonial Western Insurance Agency 751 Daily Dr. Suite 230 Camarillo, CA 93010 CONTACT NAME: PHONE 800 272 -3256 X No : 805 388 -7138 ADD�gg: INSURER(S) AFFORDING COVERAGE NAIL M INSURERA:ArCh Specialty Insurance Company LIMITS INSURED Correctional Managed Care Medical Corporation 4211 E. La Palma Ave. Anaheim, CA 92807 INSURER B: Travelers Prop Cas Co of America 25674 INSURER c : Everest National Ins Co 10120 INSURER D: INSURER E: $ 1,000, INSURER F: $ 100,00 COVERAGES CERTIFICATE NUMBER: 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. LTR TYPE OF INSURANCE POLICY NUMBER M M LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000, IT PREMISES Ea OOCtXrBrlCe 1 $ 100,00 A X COMMERCIAL GENERAL LIABILITY X CLAIMS-MADE Fl OCCUR FLP004567901 8/1!2012 811/2013 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000, GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 3,000,00 POLICY PRO LOC $ AUTOMOBILE LIABILITY EOMB�M SINGLE LIMIT 1,000,00 BODILY INJURY (Per person) $ B ANY ALTO 6809447H706TCT12 2/4/2012 2/4/2013 ALL OVIMED SCHEDULED AUTOS AUTOS BODILY INJURY (Per aceident) $ X P�PEE DAMAGE $ HIRED AUTOS X NON-OWNED AUTOS a UMBRELLA LIAS OCCUR EACH OCCURRENCE S AGGREGATE S EXCESS LIAB CLAIMS -MADE DED I J RETENTION $ i C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE YI N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA A20010966121 7/1/2012 7/1/2013 X I VVC STATU- I JOTH- E.L. EACH ACCIDENT a 1,000,00 E.L. DISEASE - EA EMPLOYEE[ ! 1,0000 0 yes describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 S 1,000, A PL / MC E &O FLP004667901 8/1/2012 811/2013 See below for limits AMOVW AS TO VMM DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remrhs Schedule, If more space is required) •30 Days notice of cancellation, 10 days for non - payment of premium. Limits: Professional Liability & Managed Care Errors and Omission $1,000,000 per Event $6,000,000 Policy A g ate. General Liability Retroactive date: 08101/2002. Professional Liability& Managed Care Errors and Omissions TEIR Certificate Holder Is Additional Insured for General & Professional Liability per endorsements (Additional Insured -Des tion & of Transfer of Rights of Recovery Against Others To Us) attached y LiGK I lr i iA 1 C MULUCK City of Santa Ana 62 Civic Center Plaza Santa Ana, CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE VVILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 26 (2010/05) The ACORD name and logo are registered marks of ACORD