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IMMIDO <br />AC R'ar CERTIFICATE OF LIABILITY INSURANCE DATE51112015m1 <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 statement on this certificate does not confer rights to the <br />certificate holder in (leu of such endorsement(s). <br />PRODUCER Keenan & Associates CONTACT <br />2355 Crenshaw Blvd., Suite 200 PHONE -"Fax <br />rHn 219 uses e, Mn. s n-212-nar,B <br />0451271 <br />INSURED <br />HoaMemorial Hospital Presbyterian <br />NNewport ggBeDarch CA 92658 `0- <br />COVFRAGFS CERTIFICATE NUMBER: 94531483 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. <br />(NSR —___ .__._- ----AODLeUBR - PO'LIOYEFF." POLICYExP '_ <br />LTR TYPE OF INSURANCE INSD WVO POLICY NUMBER QMMIODNYYYI (MM)DO/YYYYI: <br />.. .._._...._.__.. _._._...-. ___.._. ___.. <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE $ <br />-5AAf csTrT'RE'NTEO --------- ---- ...._ - <br />i CLAIMSMADE OCCUR <br />- <br />...... ._ .. '.. <br />MED EXP {Any one person) $ <br />��� <br />A <br />PERSONAL$ADV INJURY $ <br />GEN L AGGREGATE LIMIT APPLIES PER. <br />rfYVe <br />GENERAL AGGREGATE , $ _ <br />`, <br />POLICY JECT LOC �n.fw <br />PRODUCTS, $ <br />_$ <br />OTHER: <br />AUTOMOBILE LIABILITY V- <br />COMBINED SINGLE LIMIT $ <br />ANY AUTO n�V j�`.- <br />BO OI LY INJURY (Per person) $ <br />ALL COINED SCHEDULED - `' V (�(J <br />AUTOS L`��`I` (n,(h <br />BODILY INJURY (Per eccitlent) 5 <br />;AUTOS <br />NON OWNED <br />PROPERTY DAMAGE <br />;.. HIREDAUTOS (AUTOS `� <br />I_(Peraccidenn____ <br />��`.t <br />5_ <br />UMBRELLA LIPS _' ' OCCUR <br />EACH O_CC_URRENCE $ <br />EXCESS LIAB j CLAIMS -MADE - <br />yAGGREGATE $ <br />DED RETENTIONS <br />A '.. WORKERS COMPENSATION SP 4051663 '..9/1/2014 '9/1/2015 <br />V STATUTE <br />AND EMPLOYERS' LIABILITY YIN <br />_ -6RH <br />"""-" <br />ANY PROPRIETORIPARTNIINEXECUTIVE <br />CLEACH ACCIDENT 1000000 <br />OFFICERIMEMSER EXCLUDED? ❑N NIA <br />(Mandatory in NH) <br />,$_, <br />ST DISEASE _-EA EMPLOYEE _$ 1,_00_0_,_0_0_0_ <br />If y25, domar be under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE -POLICY tJMII.$ 1,000,000 <br />DESCRIPTION OF OPERATIONS ILOCATIONS I VEHICLES (POSED 101, Additional Remarks Schedule, may be aUd.h.d If mom epaae is required) <br />Verification of Excess Workers' Compensation coverage for Hoag Memorial Hospital <br />Cif Of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Attu PRCSA ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza - M-23 <br />Santa Ana CA 92701 _ <br />AUTHORIZED REPRESENTATIVE <br />©1 <br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD <br />CERT 110-: 24531483 CLIENT CO➢Na HOAGNERH Dan Mattioli 5/1/2015 1741.26 PM (PDT( Page 1 o2 1 <br />