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PROOF OF INSURANCE (2022 - 2022) CLOSEDCERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 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). CONTACT PRODUCER SullivanCurtisMonroe Insurance Services (IRV) NAME: 1920 Main Street FAX (At No-E, 0 949 250,7172 949.852 9762 Suite 600 E4Att m ,®. Irvine, CA 92614 QRR95s, INSURERS) AFFORDING COVERAGE NAIC # www.SullivanCurtisMonroe com License # OE83670 INSURED Hospital Association Of Southern California *See addendum for full list of named insureds 515 S. Figueroa Street, Suite 1300 Los Angeles CA 90071 INSURER A: COIO y n insurance COmF INSURE COmi INSURE R C : Ladndmafk American Ins INSURER D Continental Casualty Cc INSURER E LLOyd's Of London INSURER F : Llovd's Svndicate 2623 crn/FRA(_Fc ('FRTIFICCTF NIIMRFR e raJszc RFVISION NUMRFR- lil il 1 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. IL7R AdbUSUGg- NUMBER ..... TYPE OF INSURANCE POLICY091 ..,..,,.,MMIDDY/YYYY MM ' Y EXP ... LIMITS A ," COMMERCIAL GENERAL LIABILITY i103GLO18968201 11/22/2021 11/22/2022 EACH OCCURRENCE ` �.... CLAIMS -MADE OCCUR '..., PREMISE'E�(-y�cY�Cw+lr�ra $2,500 Deductible MED EXP (Any one person) s 5 000 PERSONAL & ADV INJURY s2,000,OOO GEN'LAGGREGATE LIMIT APPLIES PER: '.. GENERAL AGGREGATE s4,000,000 1111111 PRO- POLICYJFCT LOG PRODUCTS COMP/OPAGO $4i000�000 1� OfL IE LIABILITY B AUTOMOBILE 1iOOO.000 AAUTO Excess Coverage Under 11/22/2021 11/22/2022 BODIBLY IN(( JU R Perpe3rson) $ .......... OWNED -.., �� SCHEDULED iExcess Liability BODILY INJURY (Per accident) i AUTOS ONLY ,,,,,,,;AUTOS HIRED NON -OWNED ,. PROPERTYDAMAGE ,�,,, . $ >„ AUTOS ONLY ;»-„' AUTOS ONLY '.. ,1h'r.r s���"�'$¢3(III ®. Comp Ded $50W Cofl Ded $500 Excess HNOA Liability s3 000,000 IB ,. OCCUR.... XS175070 A UMBRELLALA 11/22/2021 11/22/2022 ,EACH OCCURRENCE......... S3,000,000 ✓ EXCESS LIAB ✓ CLAIMS -MADE '... AGGREGATE s3,000,.000 DED ! RETENTION $ f4 _ " WORKERS COMPENSATION PER OTH- sTATIJ,TE R AND EMPLOYERS' LIABILITY YIN , . , ANYPROPRIETOR/PARTNER/E' ECUTIVE EL EACH ACCIDENT S OFFICE R/MEMBER EXCLUDED. E N / A (Mandatory in NH) E L. DISEASE - EA EMPLOYEE S If yes, describe under DESCRIPTION OF OPERATIONS below E L. DISEASE - POLICY LIMIT 5 C 'Professional Liability Primary LCY844698 11/22/2021 11/22/2022 $2,000,000 per claim $4,000,000 Aggregate D Professional Liability 2nd Layer 652289157 11/22/2021 11/22/2022 '$2,000,000 per claim $2,000,000 Aggregate E Professional Liability 3rd Layer MPX3007721 11/22/2021 1 11/22/2022 $1,000,000 per claim $1,000,000 Aggregate F Sexual Misconduct & Molestation AUGASGO064A 11/22/2021 11/22/2022 $2,000„000 any One Victim DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) t,LKIIrIt AI "ULlU K VNIYICLLNIIVIY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE El Segundo 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 65179286 1 HOSPIASS 1 21-22 GL & Prof & 21-22,CAU I Brinda Hutchins 1 11/24/2021 7:27:11 AN. (PST) I Page 1 of 2 AGENCY CUSTOMER ID: HOSPIASS ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED Hospital Association Of Southern California __..�!!ivanCu rtis Monroe Insurance Services (IRV) full list of named insureds ...................... See addendum foi POLICY NUMBER 515 S. Figueroa Street, Suite 1300 Los Angeles CA 90071 CARRIER NAIC CODE EFFECTIVE DATE: AIJU1 I 1UNAL JKLIVIAKrS.Zo THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability (03/16) ........................ HOLDER: Ei Segundo Fire Department ADDRESS: 314 Main Street El Segudo CA 90245 .... ........ . . ...... Named Insured: Hospital Association of Southern California dba: Reddinet AllHealth, Inc. AllHealth, Inc. dba: Checkpoint Modern Health Services, Inc. National Health Foundation Inactive LLC fka: Professional Data Services, Inc. Institute for Performance Excellence, AKA: IPE California Hospital Share, LLC HBWP, LLC Communities Lifting Communities, LLC PLEASE NOTE: WE DO NOT WRITE THE WORKERS' COMPENSATION FOR THIS INSURED AND CANNOT PROVIDE PROOF OF COVERAGE. ACORD 101 (2008101) @ 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ATTACHMENT 65179286 1 140SPIASS 1 21-22 GL &. Prof &: 21-22,CAU I Brinda Hutchins 1 11/24/2021 7:27:11 AM (PST) I Page 2 of 2 DATE (MM/DDIYYYY) AC"R" CERTIFICATE OF LIABILITY INSURANCE 9/2/2021 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 CONTACT NAM.Joan Crossley_, Alliant Insurance Services, Inc. RHO NE FA 2180 Harvard Street, Suite 460 WC,Nq, xRJ 916 643 2708 643 2750 FAX (auc N�) 916 E-MAIL Sacramento CA 95815 ADDRESS jcrossley@alliant.com INSURERS) AFFORDING COVERAGE NAIC # A: Everest Premier Insurance Como 16045 INSURED California Association of Hospitals & Health Systems 1215 K Street, Suite 700 Sacramento CA 95814 COVERAGES CERTIFICATE NUMBER:207RPIS7R7 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, AD L S R: ...TYPE INSRPOLICY EFF POLICY EXP OF INSURANCE INS POLICY NUMBER LIE '......(MMIDD/YYYY MM/OD/YYYX LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S DAMAGE rO RENTED ' CLAIMS -MADE 1 OCCUR „PREMISES (Fa occurrence) 5 . . ,,,,,,,,, MED EXP An one person) 5 „ ''. PERSONAL &. ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: '.. '.. GENERAL AGGREGATE S " r 1 PR( n POLICY a JECI' I_ LOC PRODUCTS COMP/OPAGG 5 OTHER: 5 AUTOMOBILE LIABILITY '. COMMNFD MINGLE LIMIT $ ;a..Mp':'rr a4;S,adsntI' „e..,,� e. , .........,,,,e,.e, ANY AUTO '... BODILY INJURY (Per person) S OWNED " SCHEDULED BODILY INJURY (Per accident) S „„. AUTOS ONLY ,®®: AUTOS .. i HIRED "NON -OWNED ROPERTYUAMAGE PROPERTY �j ` AUTOS ONLY am AUTOS ONLY (Per,ar�.c�dent) S UMBRELLA LIAB OCCUR EACH OCCURRENCE S !. EXCESS LIAB '.. CLAIMS -MADE .......... .... .w _e, AGGREGATE S I DED RETENTION $ $ A WORKERS COMPENSATION CA10000886211 9/1/2021 9/1/2022 X PER OTH- AND EMPLOYERS' LIABILITY YIN,.._ - ...STATUTE _„FR ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? 1 A E L EACH ACCIDENT S1.000.000 ,-,.. ................... .. ..... .... ,.,.. """ElN (Mandatory in NH) '.. E,L DISEASE - EA EMPLOYEE S 1,000,000 If yes, describe under ,......... ---...... _..... '... DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT S 1,000,000 ''. DESCRIPTION OF OPERATIONS I LOCATIONS I 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 CEr,ITIFTCATE HOI r)ER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. EL SEGUNDO FIRE DEPARTMENT 314 MAIN ST AUTHORIZED REPRESENTATIVE'] EL SEGUNDO CA 90245 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD