HOAG MEMORAL HOSPITAL PRESBYTERIAN - 2015

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� ik o CERTIFICATE OF LIABILITY INSURANCE 'MIDDIYYYY) 4//9/9/2015 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 NANTACT ME, Jenny Norbeck Beecher Carlson - Santa Ana 6 Hutton Centre Drive PHONE (714)981-7101 AIC !a: EMAIL noxbeck@beechercarlson.com ADDRESS:) Suite 1260 Santa Ana CA 92707 INSURERS AFFORDING COVERAGE NAICN INSURERAHOag Memorial Hosp Self-Insd INSURED INSURER S. -National Union Fire Ins Co 19445 INSURER C: Hoag Memorial Hospital Presbyterian One Hoag Drive INSURER D: INSURER E: Newport Beach CA 92663 1 INSURER F: COVERAGES CERTIFICATE NUMBER:CL154939107 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, INSR LTR TYPEOFINSURANCE Do UeR POLICY NUMBER POLICY EFF MOLICY EFF POLICY EXP MMIDDIYYYV LIMITS A GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR X Hoag Self -Insured Program 1/31/2015 1/31/2016 DAMAGE TORENTED 100,000 PREMISES Ea occurmnce $ MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 X Professional Liability X Claims Made GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMITAPPLIES PER. PRODUCTS AGG $ 2,000,000 POLICY PFCTRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 BODILY INJURY (Per person) $ B X ANY AUTO ALL OWNEDX SCHEDULED AUTOS AUTOS A 348-25-36 1/31/2014 1/31/2015 BODILY INJURY Per accident $ ( I XNON-OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE $ Peraccident $ UMBRELLA LIAR OCCUR Rev)ew EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS"MADE :• DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY PROPRIETORIPARTNERIEXECUTIVE YIN EXCLUDED?E.L. (Mandatory In and If yes. under [NIA p J(�V(� C vV V PRICSI /1) �'+fllJOa`v o evasOFFICERIMEMBER drn(n. TANY EACH ACCIDENT $ E, L. DISEASE - EA EMPLOYE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Evidence of Healthcare Professional Liability Insurance, General Liability Insurance and Automobile Insurance for Hoag Memorial Hospital Presbyterian. Certificate holder, its officers, agents, and employees are named as Additional Insured in regards to General Liability per attached CG 2015 11/8B. City of Santa Ana Attn: PRCSA 20 Civic Center Plaza - M-23 Santa Ana, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Harper/CMILLE All rights reserved. INsn2s,�n,nn5,n, The Arnran namn nnrf Innn am raniefnreA mertre of nrnwn