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COI - American Medical Response, Inc. - Expires 2023-03-31AC~® CERTIFICATE OF LIABILITY INSURANCE I DATE(MM/DD/YYYY) ~ 05/23/2022 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 2~m~CT AOn Risk services central, Inc. f,{;a','N'"o. Ext): (866) 283-7122 I Fffc. No,): (800) 363-0105 Philadel~hia PA Office 100 Nort 18th street E~AIL l5th Floor A DRESS: Philadelphia PA 19103 USA INSURER($) AFFORDING COVERAGE NAIC# INSURED INSURER A: Indemnity Insurance co of North America 43575 American Medical Response, Inc. INSURER B: ACE American Insurance company 22667 6363 Fiddlers Green Circle· INSURER C: ACE Fire underwriters Insurance co. 20702 suite 1400 Greenwood village co 80111 USA INSURER D: Great American Security Ins Co 31135 INSURER E: Lloyd's Syndicate No. 2623 AAJ.128623 INSURER F: COVERAGES CERTIFICATE NUMBER: 570093183818 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. Limits shown are as requested 11'<::iH TYPE OF .INSURANCE iNsc 'wvo POLICY NUMBER 1liiM~bitvvvY1 IMM/DD/YYVY LIMITS LTR B X COMMERCIAL GENERAL LIABILITY XSL.G/L41So:l// Uj/ OJ./ LVLL IU:l/ :H/LUL EACH OCCURRENCE $2,750,000 -tJ CLAIMS-MADE QJoccuR SIR applies per policy ter 111s & condi· fons """'""" IUnc,,,ccu $300,000 I-PREMISES /Ea oocurrence\ MED EXP (Any one person) Exc·1 uded 1-- $2,750,000 PERSONAL & ADV INJURY ,_ $5,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE ~ POLICY □ j:gT □ LOC PRODUCTS• COMP/OP AGG $2,750,000 OTHER: SIR $250,000 B AUTOMOBILE LIABILITY ISA H25562434 03/31/2022 03/31/2023 COMBINED SINGLE LIMIT $10,000,000 I Ea accident\ -BODILY INJURY ( Per person) X ANY AUTO ,_ -SCHEDULED BODILY INJURY (Per accident) OWNED 1-AUTOS ONLY 1--AUTOS PROPERTY DAMAGE HIRED AUTOS NON-OWNED I Per accident\ -ONLY 1--AUTOS ONLY X $2,500 Coll Deduclll X $2,500 Comp Deducl D UMBRELLA LIAB H OCCUR EXC4051353 03/31/2022 O.:i;31/2023 EACH OCCURRENCE $15,000,000 ........ AGGREGATE $15,000,000 X EXCESS LIAS CLAIMS-MADE OED I I RETENTION A WORKERS COMPENSATION AND WLRC6892021SO Oj/31/2022 0:l/3L;2023 X I PER STATUTE I 10TH-EMPLOYERS' LIABILITY YIN AOS ER B ANY PROPRIETOR/ PARTNER/ EXECUTIVE ~ WLRC68920243 03/31/2022 03/31/2023 E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) CA, MA E.L. DISEASE-EA EMPLOYEI= $1,000,000 ~~;t~Ptff&~ ~w~PERATIONS below E.L. DISEASE-POLICY LIMIT $1,000,000 E E&O-PL-XS W1B173220701 03/31/2022 03/31/2023 Per claim $12,000,000 = cl a·i ms Made Aggregate $12,000,000 SIR applies per policy ter ~s & condi ·ions SIR $3,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) CERTIFICATE HOLDER IS INCLUDED AS ADDITIONAL INSURED IN ACCORDANCE WITH THE POLICY PROVISIONS OF THE GENERAL LIABILITY POLICY. A WAIVER OF SUBROGATION IS GRANTED IN FAVOR OF CERTIFICATE HOLDER IN ACCORDANCE WITH THE POLICY PROVISIONS OF THE GENERAL. LIABILITY POLICY. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE OEI.IVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. THE CITY OF GILROY AUTHORIZED REPRESENTATIVE ITS OFFICERS AND EMPLOYEES ATTN: CHIEF FOSTER ll~u 1 ftd«!t({NUe 11ta11a9e,u (USA), 1~, 7351 ROSSANA STREET GILROY CA 95020 USA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000073826 LOC#: AC~® .______., .. ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED Aon Risk services central, Inc. American Medical Response, Inc. POLICY NUMBER see certificate Number: 570093183818 CARRIER INAICCODE see certificate Number: 570093183818 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD25 FORM TITLE: Certificate ~f Liability Insurance INSURER($) AFFORDING COVERAGE NAIC# INSURER INSURER INSURER INSURER Page_ of_ I ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. INSR POLICY POLICY ADDL SUJJR POLICY NUMJJER EllJ/ECTJVF, F,XPIRATION LIMITS lll'R TYPF, OU' INSURANCE JNSD WVD DATF, DATE (MM/DD/YYYY) (MM/DD/YYYY) WORKERS COMPENSATION C N/A SCFC68920322 03/31/2022 03/31/2023 WI Paid Loss Retro -·~ ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo 11re registered marks of ACORD AC:ORb® CERTIFICATE OF LIABILITY INSURANCE I DATE(MM/DD/YYYY) ~-,. 05/23/2022 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 CONTl~ACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. 7rvi"P'ORTANT: lft'iiecortificate holder is an"7fDDITIONAL INSURED, the policy(ies) mu1st have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certa1in policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). --• PRODUCER T AOn Risk Services Centra·I, Inc. c866 ) 283-7122 / Ee~. No,l: (800) 363-0105 Phi 1 adel ~hi a PA off-Ice , Ext): 100 Nert 18th strei!t E,MAIL 15th Floor ADDRESS: Philadelphia PA 19103 USA INSURER($) AFFORDING COVERAGE NAIC# ---INSURED INSURER A: Indemnity Insurance co of North America 43575 American Medical Response, Inc. INSURER B: ACE American Insurance company 22667 6363 Fiddlers Green circle suite 1400 INSURER C: ACE Fire Underwriters Insurance co. 20702 Greenwood Village co 80111 USA INSURER 0: Great American security Ins co 31135 INSURER E: Lloyd's syndicate No. 2623 AA1128623 INSURER F: COVERAGES -CERTIFICATE NUMBER: 570093183819 REVISION NUMBER: '"riZls"~~'i'i-'i'A'f 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. -Limits shown are as requested 'L¥'R TYPE OF INSURANCE ·'1Ws'o W:Jf.. POLICY NUMBER IMMtfJ'6)yy''{y1 1MMro'6ivvv'v LIMITS 6 X COMMERCIAL GENERAL LIABILITY XSLG724B6:l77 U3;:a/,WI.L Vj/31/ LV/.j EACH OCCURRENCE $2,750,000 --=:J CLAIMS-MADE 0occuR SIR applies per policy ter ns & condi ions LJf\lVI/S\;IC I U MC" I t:IJ $300,000 -· PREMISES /Ea occurrAncAI MED EXP (Any one person) Excluded -· PERSONAL & ADV INJURY $2,750,000 --GENERAL AGGREGATE $5,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: =81 □PRO· □ $2,750,000 POLICY . JECT LOO PRODUCTS • COMP/OP AGG OTHER: SIR $250,000 B AUTOMOBILE LIABILITY ISA H25562434 03/31/2022 03/31/2023 COMBINED SINGLE LIMIT $10,000,000 Ir:a accident\ --BODILY INJURY ( Per person) X ANY AUTO --~ SCHEDULED BODILY INJURY (Per accident) OWNED AUTOS -· AUTOS ONLY r---NON-OWNED PROPERTY DAMAGE HIRED AUTOS (Per accident) ONLY r---AUTOS ONLY X $2,500 Coll Deduotlb X $2,500 Comp DeduoI D UMBRELLA LIAB H OCCUR EXC4051353 03/31/2022 I 03/31/2023 EACH OCCURRENCE $15,000,000 -· AGGREGATE $15,000,000 X EXCESS LIAB CLAIMS-MADE OED I /RETENTION A WORKERS COMPENSA'rlON ANO WLRC68920280 03/31/2022 03/31/2023 X I PER STATUTE I l~JH· EMPLOYER$' LIABILITY Y/N AOS B ANY PROPRIETOl1 / PARTNER/ EXECUTIVE ~ WLRC68920243 03/31/2022 03/31/2023 E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NI-I) CA, MA E,L, DISEASE-EA EMPLOYEE $1,000,000 ~~1§1b~ftfr&~ tn?~PERATIONS below E,L, DISEASE-POLICY LIMIT $1,000,000 E E&O-PL-XS W1B17322070l. 03/31/2022 03/31/2023 Per claim $12,000,000 claims Made Aggregate $12,000,000 SIR applies per policy ter ns & con di· .ions SIR $3,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) CERTIFICATE HOLDER IS INCLUDED AS ADDITIONAL INSURED IN ACCORDANCE WITH THE POLICY PROVISIONS OF THE GENERAL LIABILITY POLICY. A WAIVER OF SUBROGATION IS GRANTED IN FAVOR OF CERTIFICATE HOLDER IN ACCORDANCE WITH THE POLICY PROVISIONS OF THE GENERAL LIABILITY POLICY. 0. CERTIFICATE HOLDER CANCELLATION SHOULD ANY C>F THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, THE CITY OF GILROY AUTHORIZED REPRESENTATIVE ITS OFFICERS AND EMPLOYEES ATTN: CHIEF FOSTER llon 1Mt~Hee 1H-ana9e,u (USA), ?He, 7351 ROSSANA STREET GILROY CA 95020 USA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD _ ___...,, ~· Ac-c,Rc,= '-----' AGENCY AGENCY CUSTOMER ID: 570000073826 LOC#: ADDITIONAL REMARKS SCHEDULE NAMED INSURED Aon Risk services central, Inc. American Medical Response, Inc. POLICY NUMBER see certificate Number: 570093183819 CARRIER I NAICCODE see certificate Number: 570093183819 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD25 FORM TITLE: Certificate of Liability Insurance INSURER($) AFFORDING COVERAGE NAIC# INSURER INSURER INSURER INSURER Page_ of_ I ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. __,.. INSR POLICY POLICY ADUL SUBR POLICY NUMBER EJIJ/ECTIVE EXPIRATION LIMITS I,TR TYPR OF INSURANCE INSD WVD DATE UATE (MM/DD/YYYY) (MM/UD/YYYY) WORKERS COMPENSATION C N/A SCFC6892O322 03/31/2022 03/31/2023 WI Paid Loss Retro ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD