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CORRMAN -01 SEMORY
<br />14cC110MLa° CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM /DoNYYY)
<br />s/6/2o1 a
<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 forms 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 lleu of such endorsement(s),
<br />PRODUCER
<br />PhySiclans Risk Associates Insurance
<br />26891 Plaza Drive Suite 220
<br />Mission Viejo, CA 92691
<br />CONTACT
<br />NAME:
<br />_
<br />PNONE FAX
<br />VG Na y(800) 910 -6536 iuc. Nor: (949 ) 306.6166
<br />ADDRESS:
<br />INSVRERINµ,A,FFORDING COVERAGE
<br />NATO 9
<br />FLP00456 79.03
<br />MISURERIN Arch Speciatiy InSU[anCe Company
<br />EACHOCCURRENCE
<br />0910912016 P REMISES aces
<br />$ 2,000,000
<br />INSURED
<br />INSURERS: Hanover Insurance Company
<br />_
<br />INSURERC: Everest National Ins Co
<br />10120
<br />Correctional Managed Care Medical Corporation
<br />INSURERD:
<br />1475 South State College Blvd. Suite 202
<br />Anaheim, CA 92606
<br />INSURER E
<br />INSURER F: —
<br />COVERAGES CERTIFICATE NUMBER: - REVISION NUMBER:
<br />THIS I$ 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.
<br />iTR
<br />TYPE OFINSURANCE
<br />Santa Ana CA 92702
<br />POLICY NUMBER
<br />MM i
<br />WDONYYY UMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAWS-MADE F, OCCUR
<br />FLP00456 79.03
<br />0910172014
<br />EACHOCCURRENCE
<br />0910912016 P REMISES aces
<br />$ 2,000,000
<br />$, 106,00q
<br />$ 6,�
<br />MED EXP (Any one pereon)
<br />$ 2,000,000
<br />PERSONAL &ADV INJURY
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY❑ JEC 7 LOG
<br />$Y 3,000,00
<br />GEN'L
<br />GENERAL AGGREGATE
<br />PRODUCTS- COMP /OP AGO
<br />$m 3,000,000
<br />$ 1,000,000
<br />OTHER,
<br />ABUSE OR MOLEST
<br />AUTOMOBILE LIABILITY
<br />COMBINED BINDLE, LIMIT
<br />Eaeceldent
<br />$ 1,000,000
<br />B
<br />ANY AUTO �
<br />OB3A20740500
<br />02/04/2014
<br />0210M2016 BODILY INJURY (Par person)
<br />$
<br />ALL OS SCHEDULED
<br />AUTOS NON OWNED
<br />X HIRED AUTOS X AUTOS
<br />BODILY INJURY Per axldern
<br />(Per
<br />PROPERTY DAMAGE
<br />ParaccideN
<br />$
<br />§
<br />UMBRELLA UAe
<br />OCCUR
<br />-
<br />EACH OCCURRENCE
<br />a
<br />$
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />AGGREGATE
<br />OF
<br />RETENTION$
<br />§
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNERIEXECUTIVE YIN
<br />OFMOER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />If yyae, deaoribo under
<br />DESCRIPnONOFOPERATIONSbelow
<br />NIA
<br />CA20010965 -141
<br />07101/2014
<br />x STATUTE ER
<br />STATUTE
<br />07/0112016 E.L EACH ACCIDENT
<br />E.L. DISEASE EA EMPLOYEE
<br />-
<br />E.L, DISEASE POLICY LIMIT
<br />$ 1,000,00
<br />$ 1,000,00
<br />-- ----
<br />$ 1,000,00
<br />A
<br />Professional Liab.
<br />FLP0046679.03
<br />0910112014
<br />09101/2016 See Limits Below
<br />DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe aaaonetl if more space is regained)
<br />•30 Days notice of cancellation, 10 days for non - payment of premium.
<br />Limits: Professional Liability & Managed Caro Errors and Omission $1,000,000 per Event $6,000,000 Policy Aggregate. General Liability Retroactive date:
<br />0911112002, Professional Liability& Managed Care Errors and Omissions Retroactive date: 0310111998. Included under General Liability: $1,000,000 Each Claim
<br />Sub.Limit forAbuse or Molestation 1$1, 000,000 Policy Aggregate Sub -Limlt for Abuse or Molestation.
<br />Certificate Hostler is Additional insured for General & Professional Liability per endorsements (Additional Insured - Designated Person or Organization &
<br />Waiver of Transfer of Rights of Recovery Against Others To Us) attached.
<br />CERTIFICATE HOLDER . nanfrrrrllr'w ♦ Q ern F[linV6,NCELLATION
<br />IrOrrt't'' "G �-1 rra(
<br />.�tlural
<br />/`CEU EXPRATTIIONN DATEV THEREOF,E NOTICEEWI LCBEC DELIVERED RIN
<br />ACCORDANCE WITH THE POLICY PROVISIONS. '
<br />♦ rf^.�a..t'2.® ♦,L3SIQl1
<br />Assistant City A tOrBe
<br />City of Santa Ana
<br />AUTHORIZED REPRESENTATIVE
<br />62 Civic Center Plaza
<br />Santa Ana CA 92702
<br />01988 -2014 ACORD CORPORATION. All rights reserved.
<br />^.ORD 26120141011 The ACORD name and loco are renistered marks of ACORD
<br />
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