LINNEMANN, GARY M.D.-2017 - Laserfiche WebLink

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,4c m® CERTIFICATE OF LIABILITY INSURANCE DATE (MMI°D YY) 06/26/2018 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 have ADDITIONAL INSURED provisions or 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 TO Inner NAME: Andrew Atsaves ERM Co Artex Risk Solutions, Inc. PHONE (g00)7752404 FAx A¢ NO E MAIL 8840 E. Chaparral Rd l State 275 ADDRESS: INSURERS AFFORDING COVERAGE WPIC# Scottsdale, AS 85250 INSURERA: Amencan Zurich Insurance Company 40142 $ INSURED INSURER B: Employers Resource Of America Inc Labor Contractor, for cc employees of Gary A. Gnnomann, M 0., Inc dos Pacific M edical Clinic INSURER A INSURER D: 1301 S Vista Ave #250 Boise, ID 33705 1-1.1 MADE 1:1OCCUR INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:181DO04910761 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 R TYPE OF INSURANCE AINSD llWoR AUTHORIZED REPRESENTATIVE POLICYNUMBER POLICY Err shommIYYYY POLICY ESP MMADLOY) Y LIMITS COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE $ 1-1.1 MADE 1:1OCCUR PREM OR Ea occIU urrence $ M ED LAP (A by one person) $ P ERS ONA L 4A DV INJURY $ N'LA GO REGALE LIM IT AP Pit I ES PER GENERALAGGREGATE $ GE POLICY�DEpC LOC PRODUCTS-COMWOPAGG $ $ OTHER AUTOMOBILE LIABILITY Re accident) $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHULED AUTOS ONLY AUTOSED BODILY INJURY(Peraccident) $ PROPERTY DAMAGE Per acotlenl $ HIRED NON OWNED AUTOS ONLY AUTOS ONLY UMBRELLA NON OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESSHAD Cry IMSMADE DED RETENTION$ $ WORMERS COMPENSATION ANDEMPLOYERS' LIABILITY YIN )( STATUTE ER A OFFCEwm EMBEREXCL DED? TIVE NIA WCO2-78-811-03 07/012018 07/01/2019 EL EA CH AccIDENT $ 1,000,000 EL DISEASEEdEMPLOYEE $ 1,000,000 (Man Asay in NH) !V describe under DtBC`RIPTION OF OPERATIONS codes EITDISEASE-POLICY 'MIT $ 1,000,000 Location Coverage Period: 07/01/2018 07/01/2019 Client# 642191 -CA DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD IDT, Additional Remarks Schedule, mry be obaM1ed if more space is reluirm) Gar A. Linnemann, ME, Inc dba. Pacific Medical Clinic Coverage is provided a r only those cc employees 1534 E Warner Ave Ste A of but not subcontractors Santa Ana, CA 92705 to CERTIFICATE HOLDER CANCELLATION City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 Civic Center Plaza THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Santa Ana CA 92702 ACCORDANCE W IT1 THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. Tarks of ACORD