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PROOF OF INSURANCE (2021 - 2021) CLOSEDa DATE (MM/DDIYYYY) COOK " CERTIFICATE OF LIABILITY INSURANCE 11 /3012020 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 SullivanCurtisMonroe Insurance Services (IRV) )fAIorFIe _____ CONTACT 1920 Main Street 62 949.250.......� Suite 600 fal�,.N..Ed6t1a 7172...... .........- — 949,i357 iAAIL Irvine, CA 92614 APPRE94.11 INSURERISI AFFORDING COVERAGE NAIC # 0 INSURERA. Colony InSuranCe Company--39993 Hospital AssociaticrnDOf Southern California367 m -- INSURED ..... .... ..�p _ _ 2Q2t31 INSURER C : Land Company-_.......-_ INsuRERB Fedemark Ameri anolnsurance 33138 See addendum for full list of named insureds 515 S. Figueroa Street, Suite 1300 INSURERD: Continental Casualty Company ....... Los Angeles CA 90071 INSURERE: Liberty Surplus Insurance Corporator°n 10725 ...... - -- INSURERF: Lloyd's Syndicate 2623 15642 Rf1VFRA(AFS: CFRTIFICATF NIIMRFR• Irlt'7"7QA1'7 REVISION NLIMRER- 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. ..... ~ .......-T-,u ._..... ...... iNSR .° OOL �U�FI ....._.-. ..............LIMITS .. _... POLICY EFP POLICY EXP TYPE OF INSURANCE POLICY......_._._.__ LTR NUMBER M DDrYYYY I N A ,' COMMERCIAL GENERAL LIABILITY 103GLO18968200 11/22/2020 11/22/2021 EACHOCCURRENCE $2r,000,000 GAl IA I T(i�ENTt ...,.,.,. ya'',.,..� CLAIMS -MADE El q'REMI:y (n3.ia;C!„asrrgrurSa). 00 000 $5.._..x• — — �' $2,500 �eductl ..... .°... ble ......... .______ MED EXP (Any one person) ... ,.$ 5.,000 ........... ...,__._._ _PERSONAL & ADV INJURY $2,000,000 .... � .......°°...... APPLIES PER: Gq N$ AGGREGATE LIMITPER: GENERAL AGGREGAT E $4,000,000 PI"JLICY PFIO- LOC ..... ... J E C"r PRODUCTS COMP/OPAGG $4,000 000. OTHER: $ B AUTOMOBILE LIABILITY 74992589 11/8/2020 11/8/2021 COMBINED INGLE'LIMIT $1,Op0a000 ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED I BODILY INJURY (Per accident) $ AUTOS ONLY .....w. AUTOS HIRED { NON -OWNED _ P1'�OPERfYOA"mPoAGE: $ AUTOS ONLY .✓, AUTOS ONLY _ NE ar„gsLaV1 .„� i $0 CompDed $5 Ov' Cori Ded $500 Liability Deductible I A UMBRELLA LIAB OCCUR XS175070 f $'OQQ�000....... EAGG � EXCESS LIAB �/ _ CLAIMS -MADE .............___ _. ,.. °ACHOCCURRENCE ,CGCU $3000000 A . DED RETENTION $ $ WORKERS COMPENSATION PER I OTH- STATUTE ,--- AND EMPLOYERS' LIABILITY Y / N :--__ _ER ANYPROPRIETOR/PARTNERIEXECUTIVE E.L EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? NIA ,...... -_....---- ------- ......... ,..., .... ...... (Mandatory in NH) - ,E_L._DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E°L.. DISEASE - POLICY LIMIT $ C Professional Liability Primary LCY841739 11/22/2020 11/22/2021 $2,000,000 per claim $4,000,000 Aggregate D Professional Liability 2nd Layer 652289157 11/22/2020 11/22/2021 $2,000,000 per claim $2,000,000 Aggregate E jProfessional Liability 3rd Layer E05NAB4623001 �AUGAS(30064 11/22/2020 11/22/2021 $1,000,000 per claim $1,000,000 Aggregate F Sexual Misconduct & Molestation 11/22/2020 11/22/2021 $2 000 0100 a ny One'Viclim DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Ul I II-I.L+:JA.I O MUL,LPI:;rG L MN%,r-LLM I WIN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE El Se undo Fire Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 314 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. El Segudo CA 90245 AUTHORIZED REPRESENTATIVE Shelly Quinn ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 56776417 1 HOSPIASS 1 20-21 GL & Prof & 20-21,CAU I Shelly Quinn 1 11/30/2020 12:49:11 PM (PST) I Page 1 of 2 AGENCY CUSTOMER ID: HOSPIASS ADDITIONAL REMARKS SCHEDULE of ��R' Page ...........��... AGENCY NAMED INSURED SullivanCurtisMonroe Insurance Services IRV Hospital Association Of Southern California ...,, (_ ) ._. "Sea addendum for full list of named Insureds POLICY NUMBER 515 S. Figueroa Street, Suite 1300 Los Angeles CA 90071 CARRIER NAIC CODE EFFECTIVE DATE: ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ATTACHMENT 58778417 1 HOSPIA#SS 1 20-21 GL & Prof & 20-21,CAU I Shelly Quinn 1 11/30/2020 12:49:11 PM (PST) I Page 2 of 2 Hospital Association Of Southern California 1111112019 POLICY NUMBER: E000000977911 COMMERCIAL GENERAL LIABILITY Effective Date: 11/8/2019 CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED D PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE A. Section 11 — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 2. 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. 10 04 13 © ISO Properties, Inc., 2012 Page 1 of 2 O 52285961 I HOSPIASS 1 19-20 GPL XAU I Patricia Ayala 1 11/11/2019 1:28.03 PM (PST) I Page 3 of 6 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: I. Required by the contract or agreement; or Page 2 of Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. @ Ilg is Moll a°°Itic!:ry II'ric,,„ 20,12 522815,49u � tl9P:IIBP:1A S ti :1:17 n rrp-, , AIX I dlP&�yr.cia Aya1,a 11 �I/a1(201l I u,.P l,# 03 PPP ryPUTY 11 Tl yqn 4 Od 15 CG 2010 0413 " --DATE (MMIDD/Y" ACCO L> CERTIFICATE OF LIABILITY INSURANCE 3/9/2021 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 I CONTACT oanE .. _....... Cro Alliant Insurance Services, Inc. .. 4 �Jk) 916 643-2708 t 91 64 ?5_0 2180 Harvard Street, Suite 460 -..,.. .,,�.....- ......_.-..._�[ Sacramento CA 95815 APPREB ) a .. NSURER S AFF R I.�. DING COVERAGE NAIC# st National Insurance Com„___ 10120 INSURERA. Everest _ _._-. _ .... ............ ......... .... ... __ ._.....�.. INSURED CALIASS-02 INSURER ..... California Association of ......--- �......._—.._, Hos itals & Health S stems P Y INSURER c111_ ...,.°.,.-.- 1215 K Street, Suite 800 INSURER D ..�.. .... Sacramento CA 95814 INSURER E......... INSURER F : r"r'iWCOAt'-= `" rFRTIFIr ATF NIIMRFR• R7A0!>nA1RREVISION 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. ..... .... POLICY EFF POLE .. ......_-LIMITS ...����.-. "ADDL'U'BI CY EXP IL'�R POLICY NUMBER.. TYPE OF INSURANCE MM/DDIYYYY M1 lYYYY COMMERCIALLIABILITY Lm_ EACH OCCURRENCE $ ..,� OLAIMIS-MADEERAL ..: .....� V OCCUR P_fl.EPaY05E.St�rrsvaa.?),_ $....m — ED __one person) ny MERSONALA&ADV NJURY .. _..r. $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE .. GGREGAT,E $ .� PRO - POLICY JECT LOC PRODUCTSCOMOGGEl $ COM L AUTOMOBILE LIABILITY ANY AUTO BODILY INJURY (Per person) $.... OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON -OWNED PROPERTY DAMAGE'. - $ ..___. AUTOS ONLY AUTOS ONLY..P� UMBRELLA LIAR OCCUR _ OCCURRENCE EACH OCCU $ EXCESS LIAB LAIMS MADE C ..... AGGREGATE.. y DE.D RETENTION $ $ A WORKERS COMPENSATION CA10000888201 11112020 9/1/2021 �X PER UTE ( OTH STATACCIDENT ER AND EMPLOYERS' LIABILITY YIN ECUTIVE ..E..L,.,.DACH a ....___- $ 1 000 00 ,......,. , 0 ...___,. OF IC R MEMB REXCLU ED? ❑ (Mandatory m NH) NIA —L�...... ISEAS,E..-..E.P..E,M,P,LOYEE E... $ 1,000,00.�...................................... .., . If yes, describe under DESCRIPTION OF OPERATIONS below :I E.L. DISEASE -POLICY LIMIT $ 1,000„000 I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) CALIFORNIA ASSOCIATION OF HOSPITALS & HEALTH SYSTEMS DBA HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. TO WHOM IT MAY CONCERN AUTHORIZED REPRESENTATIVE A �%&Cto_ I 'Adlr� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD