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GARYA-1 OP ID: P3 <br />CERTIFICATE OF LIABILITY INSURANCE <br />D06/2312ATE 0 1 5 V) <br />06/23/2015 <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(les) 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 <br />Granite Insurance & E -COMP <br />6600 Koll Center Parkway #100 <br />Pleasanton, CA 94566 <br />Acorn Payroll Services <br />CONTACT Michelle Lillard <br />PHONE FAX <br />AIc Esd,926-462.8400 Alc Ne: 926.462-8888 <br />E-MAIL <br />ADDRESS: <br />INSURERS) AFFORDING COVERAGE NAICIf <br />INSURERA: Hartford Insurance Company 22357 <br />EACH OCCURRENCE $ <br />INSURED Gary A Linnemann MD Inc <br />Pacific Medical Clinic <br />1534 East Warner Ave #A <br />INSURER 8: <br />INSURER C <br />INSURER D: <br />Santa Ana, CA 92705 <br />INSURER E <br />PERSONAL &ADV INJURY $ <br />NSURERF: <br />GENERAL AGGREGATE $ <br />COVERAGES CERTIFICATE NUMBER: 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 />(LTR <br />TYPE OF INSURANCE <br />INSO ADDL <br />SUER-ZWa <br />POLICY NUMBER <br />POLICY EFF <br />MMIO�IYYY1' <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />F7 OCCUR <br />EACH OCCURRENCE $ <br />RENTED <br />DAMACLAIMS-MADE <br />PREMISES RENTED <br />PREMISES $ <br />MED EXP (Any one person) $ <br />GENE <br />PERSONAL &ADV INJURY $ <br />AGGREGATE LIMIT APPLIES PER: <br />POLICY ❑ PRO- <br />JECT L__] LOC <br />OTHER: <br />GENERAL AGGREGATE $ <br />PRODUCTS - COMPIOP AGG $ <br />$ <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />HIRED AUTOS NON -OWNED <br />AUTOS <br />COMBINED SINGLE LIMIT $ <br />Ea accident <br />BODILY INJURY (Per person) $ <br />BODILY INJURY (Per accitlent $ <br />PROPERTY DAMAGE - $ <br />Peraccident <br />UMBRELLA LIAB <br />EXCESS LIAB <br />OCCUR <br />CLAIMS -MADE <br />EACH OCCURRENCE $ <br />AGGREGATE $ <br />OED RETENTION$ <br />$ <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICERIMEMBER EXCLUDED? <br />(Mandatory In NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />76WEGKZ9414 <br />0610512015 <br />05101/2016 <br />PER OTH- <br />STATUTE ER <br />E.L. EACH ACCIDENT $ 1,000,000 <br />E.L. DISEASE - EA EMPLOYEES 1,000,000 <br />E, L. DISEASE - POLICY LIMIT $ 1,DDD,D6D <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />Re: Gary A Linnemann MD Inc, dba Pacific Medical Clinic, 1534 E Warner Ave., <br />Ste A, Santa Ana, CA 92705. <br />CERTIFICATE HOLDER CANCELLATION <br />©1988-2014 ACORD CORPORATION. <br />ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD <br />All rights reserve, ' <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Ci of Santa <br />City Ana <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza <br />Santa Ana, CA 92702 <br />AUTHORIZEEjD' REPRESENTATIVE <br />©1988-2014 ACORD CORPORATION. <br />ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD <br />All rights reserve, ' <br />