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2017/11/11 Healthcare Systems Management Group Certificate of Liability Insurance._t__DATE IMMIDOPMY) ACCO CERTIFICATE OF LIABILITY INSURANCE 07/30/2018 THIS CERTIFICATE 15 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). coNTAeT JAY LAWSON PRODUCER NAME: $tafl?FBrin? JAY LAWSON, AGENT PHONE (g18) 700-1744 we No: (8i$) 700-1754 A C No STATE FARM INSURANCE apDREss: JAY@LAWSONAGENCY.COM 729 NORDHOFF ST INSURERS AFFORDING COVERAGE NAIL # 19 NORTHRIDGE CA 91324 INSURED INSURERA: State Farm General Insurance Company 25151 State Farm Fire and Casualty Company 25143 HEALTHCARE SYSTEMS MANAGEMENT GROUP INSURER D. 438 E KATELLA AVE STE 230-231 INSURER E : ORANGE CA 92867 INSURER F COVERAGES CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUR INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS 'YR TYPE OF INSURANCE POLICY NUMFStK MMruurr r r . COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ® OCCUR A Y Y 92-CTS418-7 G 11/1112017 11111f2018 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JEC El LOC AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAR OCCUR EXCESS LIAS CLAIMS -MADE DD RE ETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N B ANY PROP Ir7ORMBER PARTNEWEEXCLUDEDECUTIVE N r A 92-EW-H718-9 02/01 /2018 02/01/201 i OFFICERIM(Mandatory in NMI if vas describe under PROFESSIONAL LIABILITY IPS5141502 03/27/2018 031271201! IXI CLAIMS -MADE DESCRIPTION OF OPERATIONS 1 LOCATIONS f VEHICLES {ACORD 101, Additional Remarks Schedule, may be attached if more space is req ADDITIONAL INSURED: The City of Manifee, its officers, agents and employees named as additionally insured. ADDITOINAL INSURED: CITY OF MANIFEE 29714 HAUN ROAD MANIFEE, CA 92586 ACORD 25 (2016103) TION ©owlolrW IJI IeI192C0 =D NAMED ABOVE FOR THE POLICY PERIOD DOCUMENT WITH RESPECT TO WHICH THIS D HEREIN IS SUBJECT TO ALL THE TERMS, UMITS EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED 100,000 PREMISES Ea occurrence $ MED EXP (Any one Person) $ 5,000 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 PRODUCTS - COMPIOP AGG $ 4,000,000 BUS. PROPERTY $ 15,900 COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accdent) $ PROPERTY DAMAGE Per accident $ EACH OCCURRENCE $ AGGREGATE $ PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 EACH OCCURRENCE $1,000,000 sired) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ,"8fr-#ftgi XCORD CORPORATION. All rights reserved. The ACORD name and logo are reg ered Warks of ACORD 1001486 132849.12 173-16-2016 6028AU ADDITIONAL INSURED (Prior Notice of Termination) This endorsement is a part of your policy. Except for the changes it makes, all other terms of the policy remain the same and apply to this endorsement. It is effective at the same time as your policy unless a different effective date is specified by us in writing. It is agreed that LIABILITY — COVERAGE A of your policy is extended to the party named on the declarations page as an Additional Insured. The Additional Insured is subject to the provisions of the policy granting coverage to an insured other than you- The Additional Insured: Has the same right of recovery under this policy as before; 2. Is not liable for any premium or other expense under this policy; 3. Is not a member of the State Farm Mutual Automobile Insurance Company of Bloomington, Illinois. This policy will not be changed or terminated as to the interest of the Additional Insured unless we give such insured notice. The number of days' notice we will give is ten unless another number is shown on the declarations page. POLICY HOLDER: HEALTHCARE SYSTEMS MANAGEMENT GROUP 438 EAST KETELLA AVENUE, STE 230-231 ORANGE, CA 92867 GENERAL LIABILITY: Policy Number 92-CT-S418-7 G WORKERS COMPENSATION: Policy Number 92-EW-H718-9 PROFESSIONALLIABILITY: Policy Number PS5141502 Effective 11/11/2017 TO 11/11/2018 Effective 02/01/2018 TO 02/01/2019 Effective 03/27/2018 to 03/27/2019 CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED: CITY OF MANIFEE 29714 HAUN ROAD MANIFEE, CA 92586