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COI - Optumserve Health Servies, Inc. - Expires 2024-05-01AccRH CERTIFICATE OF LIABILITY INSURANCE DATE (M0/ D/YYYY) 05/12/2 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 Marsh USA Inc. 333 South 7th Street, Suite 1400 Minneapolis, MN 55402-2400 Attn: Healthcare.AccountsCSS@marsh.co, CN101631729-ALL-GAWUP-22-24 , NAME CT Enterprise Risk Financing & Insurance JA/C, No, Ext): (952) 936-1650 (A/C, No): 888-299-6422 E-MAIL eis uh .com ADDRESS: @ 9 , i F 1,p48..1307.. �/v7rr`"g'� i-':. u , INSURER(S) AFFORDING COVERAGE NAIL # INSURER A : Old Republic Insurance Company 24147 INSURED OPTUMSERVE HEALTH SERVICES, INC 328 FRONT STREET SOUTH LA CROSSE, WI 54601 MAY 2 3 2022 GILROY CITY CLERK'S OFFICE ..s..r�wse.. INSURER B : XL Specialty Insurance Company 37885 INSURER C : Travelers Property Casualty Company of America 25674 INSURER D INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: CHI-009772647-05 REVISION R",UMBER: 6 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, INSR LTRINSD TYPE OF INSURANCE ADDL SUBR WVD POLICY NUMBER POLICY EFF MI M/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X X MWZY315405-24 05/01/2022 05/01/2024 EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1,000,000 MED EXP (Any one person) $ 2,500 PERSONAL & ADV INJURY $ 2,000,000 GEN'L X AGGREGATE POLICY OTHER: LIMIT APPLIES PRO-T JEC PER: LOC GENERAL AGGREGATE $ 4,000,000 PRODUCTS - COMP/OP AGG $ 4,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO OWNED SCHEDULED AUTOS NON -OWNED AUTOS ONLY X X MWTB315404-24 05/01/2022 05/01/2024 COMBINED accident) LIMIT $(E5,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE X US00075258L122A 05/01/2022 05/01/2023 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 DED RETENTION $ $ C C WORKERS COMPENSATION AND EMPLOYERS' LIABILITYC ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N N / A UB-6R864629-22-NC-T (AOS) UB-6R80648A-22-NC-R (MA & WI) HWXJUB-472M4779-TIL-22 XWC OH)05/01/2022 ( (SIR $2M - XWC OH) 05/01/2022 05/01/2022 05/01/2023 05/01/2023 05/01/2023 X PER STATUTE OTH- ER E.L. EACH ACCIDENT $ 2,000,000 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 E.L. DISEASE - POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) RE: CALIFORNIA COVID-19 TESTING SERVICES ADDITIONAL INSURED: CITY OF GILROY, ITS OFFICERS, REPRESENTATIVES, AGENTS, AND EMPLOYEES THE GENERAL LIABILITY AND AUTOMOBILE LIABILITY POLICIES INCLUDE A BLANKET ADDITIONAL INSURED ENDORSEMENT FOR PERSONS OR ORGANIZATIONS WHERE THE NAMED INSURED IS OBLIGATED TO PROVIDE SUCH STATUS BY WRITTEN CONTRACT OR AGREEMENT, ONLY TO THE MINIMUM EXTENT REQUIRED AND SUBJECT TO POLICY TERMS AND CONDITIONS. THE GENERAI LIABILITY, AUTOMOBILE AND UMBRELLA LIABILITY POLICIES INCLUDE WAIVER OF SUBROGATION ON A BLANKET BASIS WHERE REQUIRED BY WRITTEN CONTRACT WITH THE NAMED INSURED. CERTIFICATE HOLDER CANCELLATION CITY OF GILROY 7351 ROSANNA STREET GILROY, CA 95020 ACORD 25 (2016/03) 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 WeelVt4 7€aS" 4 Teee, © 1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD