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PROOF OF INSURANCE (2019 - 2019) CLOSED DATE(MMIDDIYYYY) ACC>R" CERTIFICATE OF LIABILITY INSURANCE 12113/2018 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(les)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 1 FAX Siancrtismoroe Insurance Services ` E: 111. Xtlr,.. �920ManPHNE 949.250.7172 .. , : ....................-949.8529062 Suite MAIL .., Irvine, CA 92614 -AP-p.RE.sS;. ... INSURER(S)AFFORDING COVERAGE„ ,,_.......,N.AIC#,,,,.... INSURED w.Su Iva isMonroe.com License# .. 24856 U INSURER B Fede AS ....... Admiral Insurance Company AM Pest: V . Hospital V t:A+XV 20281 n Iral Insurance Company AM Best A++X fa Association Of Southern California I 515 S. Figgueroa Street, Suite 1300 INSURER C: — Los Angeles CA 90071 INSURER D: _ INSURER.E: INSURER F: COVERAGES CERTIFICATE NUMBER: 45920322 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. ADOL_._ X.., ...I INSRR .... ..,JNM SUSR POLICY tela. BER (MMIDDffYYYYI IMMIDDYYEXP LIMITS A COMM RCIALOGENERALN IABILITY E0000009779 �" EACH OCCURRENCE $5,000,000,,, s... NUM I EACH OCCURRENCE F�EN1'Eb Y II 11 11/8/2018 111/8/2019 CLAIMS-MADE C M OCCUR P,�FMI$ 5,.(Fa,oeeurrence) --„5300,000 �/ $7n500 Eacl1 Ciajm Dedu'clilalB MED EXP(Any one person) $5,000 GEN'L AGGREGATE LIMIT APPLIES.... PER ,-._.... PERSONAL&ADV INJURY ,$,5,,0,00,000 .. ....... GENERAL AGGREGATE $7,000,,0,00 ...'!r_ POLICY G.........I Gw ❑ LOC PRODUCTS-COMP/OPAGG $7,000000,,,,,,, ..... 01HER: $ . B AUTOMOBILE LIABILITY 74992589 11/8/2018 11/8/2019iy*SINGLE ,1,,,OOQ,000 F;wMXCjVtED .uIT $ .................... ANY AUTO BODILY INJURY(Per person) $ OWNED II SCHEDULEDaccident) $ AUTOS ONLY ,” AUTOS �BODI.,LY INJURY(Per AUTOS ONLY AUTOS ONLY RO' ICWi rY DAMAGE 01IaE $ HIRED 11 p NON-OWNED ablltvDedUCtible O V Comp DPd$5 W Coll Ded$500 . UMBRELLA LIAR �'OCCUR EACH OCCURRENCE EXCESS LIAR $ E _ CLAIMS-MADE V AGGREGATE $ DE p RETENTION$ $ WORKERS COMPENSATION E OTH- AND EMPLOYERS'LIABILITY YIN ER_ SCT C ENT $ OFFICER/MEMBER EXCLUDED?ANYPROPRIETORIPARTNER/EXECUTIVE NIA P DISEASE ID (Mandatory in NH) E.L.DIS EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below EX.DISEASE-POLICY LIMIT $ A ,Professional Liability,Claims Made E000000977911 11/8/2018 11/8/2019 $5,000,000 per claim$7,000,000 Aggregate $7,500 Deductible A 'Sexual Abuse&Molestation-PL Only E000000977911 11/8/2018 11/8/2019 $2,000,000 per claim$2,000,000 Aggregate 1 $7,500 Deductible DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION EI Se undo Fire Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE P THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 314 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. V EI Segudo CA 90245 AUTHORIZED REPRESENTATIVE Chrystal Rott ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 95920322 1 HOSPIASS 1 1e-19 GPL ,CAU I Tayler Outlaw 112/13/2010 9:09:15 PM (PST) I Page 1 of 2 Hospital Association Of Southern California 11/7/2017 POLICY NUMBER: E000000977910 COMMERCIAL GENERAL LIABILITY Effective Date: 11/8/2017 CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE oz_ Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations Any person or org,aniation that is an owner of real property All locations at which the Named Insured is performing cr,peesonal property on which you are performing ongoing ongoing operations. operaCipns,or a contraoCor on whose behalf you are arformang oe�goln,r operations,bttt only if covers a as an additional)nsurad)s rerpu'rred C>y a writtan contractor written agreement that ds an'"insurad oondract"and providedChe bodlpy inyyury'"or'"property damage""first occurs,or the gersonaf and advert(sinc�lnJ'rdr offense is first committed, aulasect�rent Co the exeot��ion o6 the contract or agreement. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", "property This insurance does nota I to "bodily injury" or 'property damage occurring after: damage" or "personal and advertising injury" apply y caused, in whole or in part, by: 1. All work, including materials, parts or 1. Your acts or omissions; or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. 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. CG 20 10 04 13 © ISO Properties, Inc., 2012 Page 1 of 2 ❑ 38739344 HOSPIASS 1 17-18 GPL ,CAU I Amanda LeMmon 1 11/7/2017 5:00:48 PM (PST) I Page 4 of 5 C. With respect to the insurance afforded to these 2. Available under the applicable Limits of additional insureds, the following is added to Insurance shown in the Declarations; Section III—Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable Limits of Insurance shown in the will pay on behalf of the additional insured is the Declarations. amount of insurance: 1. Required by the contract or agreement; or Page 2 of 2 @ ISO Properties, Inc., 2012 CG 2010 0413 39739344 1 HOSPIAss 1 17-19 GPL ,CAU I Amanda Lemmon 1 11/7/2017 5:00:48 em (FST) I page 5 of 5 AGENCY CUSTOMER ID: HOSPIASS LOC#: ACC?RE? ADDITIONAL REMARKS SCHEDULE Page of (AGENCY NAMED INSURED Hospital Association Of Southern California SullivanCurtisMonroe Insurance Services 515 S,F1 ueroaa Street,Suite 1300 POLICY NUMBER _a LOS Angees CA 90071 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE:Certificate of'Liability(03)15) HOLDER: EI Segundo Fire Department ADDRESS:314 Main Street EI Segud'o 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 6 PLEASE NOTE: WE DO NOT WRITE THE WORKERS' COMPENSATION FOR THIS INSURED AND CANNOT PROVIDE PROOF OF COVERAGE. THE CARRIER DOES NOT WRITE PREMISES MED PAY IN CA SO WE CANNOT EVIDENCE IT. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ATTACHMENT 95920322 1 HOSPIASS 1 18-19 GPL ,CAU I Tayler Outlaw 112/13/2018 9:09:15 PM (PST) 1 Page 2 of 2 Hospital Association Of Southern 11/7/2017 California Policy Number: E000000977910 AIr, 06 54 0410 Effective Date:11/08/2017 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: PROFESSIONAL LIABILITY COVERAGE PART In consideration of the premium charged,it is agreed that the following is added as an additional insured: As Required by Written Contract but only as respects liability caused,in whole or in part,by the operations of the Named Insured. ALL OTHER PROVISIONS AND STIPULATIONS REMAIN UNCHANGED, AE 06 54 0410 Page 1 of 1 38739344 1 HOSPIASS 117-18 GPL ,CAU I Amanda LeMmon 111/7/2017 5:00:48 PM (PST) I Page 3 of 5 0 � DATE(MMIDDIYYYY) Aaa' C)RL ► CERTIFICATE OF LIABILITY INSURANCE 10/9/2018 il",i 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 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 endarsement(s)„ Ac Crossley plc Noy' ' 43-2'750 iant Insurance HONE 21180 Harvard Street Suite 460 EEA a tycras6tle4 aNlsant.com I” . '..., 15„5 Sacramento CA 95815 aI?.p.8,. 5. I Y ............._ . .......................... INSURER(SIAF,FORDING COVERdBGE................,..........__ ,,............ -- -,..NAIC 0 Company............ ................. ........... .. ............. .............. . .ArusuRRA;Everest National Insurance ... INSURED CALIASS-02 INSURER B California Association of INSURERc: Hospitals&Health Systems IN 1215 K Street, Suite 800 I8.E5 D Sacramento CA 95814 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER.: 1024314151 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, CLAIMS. S,APD CONDITIONS OF SUCH POLICIES LIMITS SHOWN POLICY'NUMB'E'R REDUCED„�,... PoLw EXP'” .... BY P AID AODL SUeP POLICY E EXCLUSION MAY HAVE BEEN gNTSRR I F ...,,, LIMITS p�VMPo ,rYww MMrtisDrYYYwI COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE .�_ lf7ertlf, ...., U CLAIMS-MADE V , SMA sC � FFrvI1EI� IIII OCCUR Pf $ PERSONAL&ADV INJURY S EN'U AGGREGATE LIMIT APPLIES PER: — 1111 __ GENERAL AGGREGATE pppp 5 -- ............. _. µ�POLICY p C0'T' r 1 PRODUCTS-COMLP/OP AGG q S --- �----- LOC COMBINED S1�1...... $ .., OTHER, ..........0 AUTOMOBILE LIABILITY a ac&vd0l I' _ _$ BODILY INJURY(Per p tl~, �� ..... ANY AUTO person) $ �u d n9 $ ALL OWNED SCHEDULED e AUTOS AUTOS INJURY(Peracci BODILY NON-OWNED PROPERTY DAMAGE $ LFac"!,Stlbfm HIRED AUTOS AUTOS i $ UMBRELLA LIAB OCCUR .�"T"O REC*ATE EXCESS,LIAB �.........�CLAIM'S-MADE. . AgKgCCUIRRE„Y............... $ „ DE'D RETENTION$” YIN PER CTI$ A WORKERS COMPENSATION CA10000888181 9/1/2018 9/1/2099 E LIB EACH T� CCID $,.. ANY PROPMETORd' ARTNERVEXEC'UTXVE _`.� A - NIA .. SE-EENT ...£�f47OO.C7C70 AND EMPLOYERS'LIABILITY i OErI(.CRltrIEtABFR EXCLUDED? E L4iDm.�CA..,.�..mN.,m,..._--- (fins,de In NH E L DISEASE-R°''OR.tlCY LIMIT I$,,,000,000 A EMPLOYEE, I pd yy'S6,describe under DES'CIRIP'G6ON C)=OPERATIONS bpluw' .000'000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CALIFORNIA ASSOCIATION OF HOSPITALS&HEALTH SYSTEMS D'BA HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA CERTIFICATE HOLDER, 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. I TO WHOM IT MAY CONCERN AUTHORIZEDREPRESENTATIVE %�t/1�/wr_A u ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD