2022/03/31 American Medical ResponseMSC#17755
Aon Flisk Services
PO gox 1447
Lincolnshko, lL 60069
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CITY OF IVIENIFEE AND ITS OFFICERS
EMPLOYEES, AGENTS, AND
AUTHORIZED VOLUNTEERS
29714 HAUN ROAD
MENIFEE CA 92586
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05D3/2022
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CEBTIFICATE HOLDEB. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSUBANCE OOES NOT CONSTITUTE A CONTBACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPHESENTATIVE OR PNODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: ll tho certificate holder le an ADDITIONAL INSURED, th6 policy(ies) musl h.vo AOOITIONAL INSURED provisions or bo endorsed. l,
SUBROGATION lS WAIVEO, subl6ct lo lhs terms and condilions ol the policy, cerlain policios may r6quiro an ondorsement. A 3talement on this
conificato does not confor righls to lho cerlificate holder in lieu ol such endorsemont(3).
(866) 283-7122 (E00) 163-0105
PNODUCEA
Aon Risk Services Central, Inc
PhiladelDhia PA office100 North l8th street1sth FloorPh'iladelphia PA 19103 usA INSUFEF(S) AFFONOING COVERAGE
TNSUFEBA: Indemnity Insurance Co of North ameriaa 44575
|NSUFERA: acE american Insurance company 22667
tNsuFEFC: acE Fjre underwriters Insurance co 20702
t suaERor Great anerican Security Ins co 1113 5
|NSUFERE: Lloyd's Syndi(ate No. 2623 ^a112862l
INSUhED
ameri can Medical Response
Ambulance Servi ce, Inc895 Marlborouoh AvenueEivarsidp.a q2 SO7 usa
A.(-ORi)a CERTIFICATE OF LIABILITY INSURANCE
ERTIFICATE NUMBER | 57009s173836 REVISI N NUMBEB:
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THIS IS TO CEBTIFY THAT THE POLICIES OF INSUBANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOO
INDICATED, NOTWIIHSIANDING ANY REOUIREMENT, TEBM ON CONOITION OF ANY CONTRACT OR OTHER DOCUMENT WITH FESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OB MAY PERTAIN, THE INSURANCE AFFOROED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIM]TS SHOWN MAY HAVE BEEN REOUCEO BY PAID CLAIMS. Ltmhs 3hown aro as roquBlred
EACN OCCURBENCE s2, 750,000
PREMISES rE. m.uii6..6)$300,000
MED EXP (A.y o.. p.Bo.)Exclud€d
PEFSONALA ADV NJI]RY 52,750,000
GENERALAGGFEGAIE s5 ,000,000
PROOUCTS COMP]OPAGG $2,750,000
COMMEACIAL GENEAAL LIABILIIY
GEN'L AGGAEGATE LIM TAPPL ES PEF
LOCJECTPOLICY
OTHEB
SIR applies per policy ter
XSIG/24BtJl/ /
ns & condi'
03 /3L/ZOZ3
:ions
!250,000
COMBINEO S!NGLE LIM T s10,000,000
BOoILY NJURY (Por poGon)
BODILY NJURY (Por accd6nl)
rsa H2 5 5 62414 01/3t/2022 o)/)7/202aB
OWNED
AUTOS ONLY
SCI,iEOULEO
NON.OY{NEO
AUTOS ONLY
AUTOMOBILE LIAAITITY
EACI] OCCLJFFENCE $15,000,000
AGGREGAIE J15,000,000EXCESS LIAB
OCCUF
CLA|ills.MADE
DED FETEN'IION
Exc4051l5l o3/31/2022 01/1r/2021
X olrl
E,L EACNACCIDENI $r,000,000
E,L OISEASE,EAEMPLOYEE $1,000,000
B
WORXEFS COi'PE NSANON AND
€i.PTOYEFS' LIABILTTY
ANY PFOPR]ETOF / PARIiIER/ EXECUTIVE
OFFICEF/MEMBEA EXCLUDEOT
oEscF PTtoN oF oPEFAIloNs b.row
rN
r,r1Rc68920280
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wLRC6892024l
CA, I{A
o3/31/zo?2
03/31/2022
03/3t/2O23
03/31/2O23
E,L OISEASE.POL CY LIMII $r.,000,000
03/31/2O23EE&O PL.XS w\Bt7 322070!
SrR applies per policy ter
o3/3t/2022
ns & condil
Per claim
aggreqate
SIR
51?,000,000s12,000,000
5r,000,000
oESCRIPIION OF OPEFAiOI€ / lOCAllOllS/ VEHTCIES (lCOnD 101, &dl oml Fmri. S.h.duL, my n .Mch.d It mm.r&. lt.q!lr.d)
CITY OF MENIFEE AND IT5 OFFICERS, EMPLOYEES, A6ENT5. ANO AUTHORIZED VOLUNTEERS ARE INCLUDED AS ADOITIONAL INSURED IN ACCORDANCE
WITI] TIIE POLICY PROVISIONS OT THE AUTOI9OBILE LIABILIIY POIICY.GENERAL LIABILITY POLICY EVIOENCED IIEREIN I5 PAIMARY AND
NON-CONTRIBUTORY TO OTTIER INSURANCE AVAILABLE TO AN ADDITIONAT INSURED, BUT ONLY IN ACCORDANCE W]TH THE POLICY'S PROVISIONs, AS
REQUIRED 8Y I9R]TTEN CONTRACT,
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ECERTIFICATE HOLDER CANCELLATION g
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01988-2015 ACORD CORPORATION. All rlghts ressrysd.
The ACORD name and logo are registered merks ol ACORD
SHOUIo Ar,lt OF THE AAOVE OESCAIa€D POLICIES BE CANCELIEo BEFOBE IhE
EXPIFATION OATE IHEFEOf, NOIIC€ WLf AE DELIVEFEO IN ACCOFO^I{CE WTIH IHE
.iTY OF MENIFEE ANO ITS OFFICERS
EMPLOYEESI AGENTS, AND
AUTHORIZEO VOLUNTEERS29714 HAUN ROAD
MENIFEE CA 92586 UsA 4u 1 auaxz %4,r44c,,t WSril, I'u.
ATTTHOFIZEO RE PRESEHTATIVEEFJ ITE..fi
acoBD 25 (2016/03)
AOOAESS
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TTOfIUTEET
aGENCY CUSTOMER tD: 570000073826
LOC f:
ADDITIONAL REMARKS SCHEDULE Page _ of _
AGENCY
Aon Risk Services Central , Inc.
NAMED INSI,JFEO
Ame ri can Medical Response
see certifi cate Number: 570093L73836
See certi fi cate Number: 570093173836
NAIC CODE
ADDITIONAL BEMARKS
THIS ADDITIONAL FEMABKS FORM IS A SCHEDULE TO ACORO FORM,
FORM NUMBEB: ACORD 25 FORM TITLE: Certiticate of Liabilily lnsurance
INSUHER(S) AFFORDING COVERAGE
INSI.]RF,R
INSI ]RI.]R
INSTJRF:R
INSIIRER
AI)I)ITI0NAI, POI,ICII]S lf a policy below does not include limit iniormation. rcfcr to the corresponding policy on rhc ACORD
certificate form for policy limits.
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DATI]
P()LICY
IjXPITATION
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V'/ORKERS COMPENSATION
C scFC68920322wI Paid Loss Retro
01/ 3t/2022 03/ 3t/2023
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acoBD 101 (2008/0r)
The ACOFO name and logo aro r€gislerod mark3 ol ACOFD
O 2008 ACOFD COFPOFATION. All righls reserved.
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