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" CERTIFICATE OF LIABILITY INSURANCE <br />9/11/2017 <br />THIS CERTIFICATEIS 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 have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this <br />certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PROD CER <br />PAYCHEX INSURANCE AGENCY INC/PAC <br />250881 P: F: (888) 443-6112 <br />PO BOX 33015 <br />SAN ANTONIO TX 78265 <br />CONTACT <br />NAME: <br />PHONE FAx <br />(NC, No, Ext): (888) 443-6112 <br />F.MAIL <br />ADDRESS: <br />INSURER(S) AFFORDING COVERAGE NAICN <br />INSURERA: Hartford Ins Co of the Midwest 37478 <br />INSURED <br />COMMUNITY HEALTH INITIATIVE OF ORANGE <br />COUNTY <br />1505 E 17TH ST STE 121 <br />SANTA ANA CA 92705 <br />INSURERS: <br />INSURER C: <br />INSURER D: <br />NBCRER F: <br />INSURERF. <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 <br />TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, <br />INSR <br />ITR <br />TYPE OP'/NSUFANCE <br />ADDL <br />IAWR <br />SUES <br />WR) <br />POLICYNUMQER <br />POL/CYEFP <br />MM/OD/YYYY <br />AMICYAXP <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE $ <br />CLAIMS -MADE ❑OCCUR <br />DAMAGE TO RENTED $ <br />PREMISES Ee occurrence) <br />MED EXP (Any one person) $ <br />PERSONAL B ADV INJURY $ <br />GENT AGGREGATE LIMIT APPLIES PER: <br />POLICY [::] PRO- ❑ LOC <br />JECT <br />GENERALAGGREGATE $ <br />PRODVCTS-COMP/OP AGO $ <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />(Ea accident) $ <br />BODILY INJURY (Per par son) $ <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLYAUTOS <br />BODILY INJURY (Per Rccldent) g <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />PROPERTY DAMAGE <br />(Peraccidenp $ <br />$ <br />UMBRELLA LIAR <br />OCCUR <br />EACH OCCURRENCE $ <br />AGGREGATE $ <br />EXCESS MAE <br />CLAIMS -MADE <br />DEe RET[NTION$ <br />$ <br />IYORKtey COMI'£N.SATION <br />ANDEMPLOYENS'LLABRITY <br />PEROTH- <br />`Y STATUTE ER <br />A <br />ANY PROPRIETOR/PARTNER/EXECUTIVE YIN <br />OFFICERIMEMBER EXCLUDED? <br />(Mandatary In NH) ❑ <br />NIA <br />76 WEG PK2991 <br />11/01/2016 <br />11/01/2017 <br />E.L. EACH ACCIDENT $1 000 000 <br />I I <br />E.L. DISEABE- EA EMPLOYEE $1, 000, 000 <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE -POLICY LIMIT $1, 000, 000 <br />DESCRIPTION OF OPERATIONS/LOCATIONS/ VEHICLES (ACORD ID1, AIIIII nal Remarks Schodale, may heattached if mareapace isregoirad) <br />Those usual to the Insured's Operations. <br />1. . <br />iea:aoLne.ra:L•I�na: .r.�arNyvauaa <br />501988.2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED <br />BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE <br />DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. <br />FOR INFORMATIONAL PURPOSE ONLY <br />AUTHORIZED REPRESENTATIVE <br />1505 E 17TH ST STE 121 <br />SANTA ANA, CA 92705 <br />/ <br />501988.2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />