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HomeMy WebLinkAboutCOI - American Medical Response, Inc. - Expires 2027-03-31 Cert No. 570118657623�-/ ,. Ate �' CERTIFICATE OF LIABILITY INSURANCE DATE(MMIOLVYYYY) 03/29l2026 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 I5 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 Aon Ri sk Services Central, Inc. Phi I adel phi a PA Offi ce 100 North 18th Street 16th Floor Philadelphia PA 19103 USA CONTACT PAME: (( C.. No. Ext): (866) 283-7122 FAX No.): (800) 363-0105 E-MAIL ADDRESS: INSURERS) AFFORDING COVERAGE NAIC # INSURED American Medical Response Inc 4400 State Hwy 121, Ste.700 Lewisville TX 75056 USA INSURER A: ACE American Insurance Company 22667 INSuf1ERB: indemnity Insurance Co of North America 43575 INSURERC: ACE Fire underwriters insurance Co. 20702 INSURERD: Underwriters at Lloyds 32727 INSURERE: ACE Property & Casualty Insurance Co. 20699 INSURER F: COVERAGES CERTIFICATE NUMBER: 570118657623 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 "INSR LTR TYPE OF INSURANCE ADDL INSD SUER WVD POLICY NUMBER POL3CVEFF 1MMfDD/YYYY FOLTC4EXP {{MMiDDIYYYY}} LIMITS A X COMMERCIAL GENERAL LIABILITY XSLG49383034 II-03/31/2020 t13/31/2027 EACH OCCURRENCE $2 , 750, 000 CLAIMS -MADE IX (OCCUR SIR applies per policy terns & condi_ions DAMAGEED PREMISES (Ea occurrence) $100,000 MED EXP (Any one person) 110,000 PERSONAL$ ADV INJURY $2,750,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $5,000,000 X POLICY PRO LOC JECT PRODUCTS - GOMPIOPAGO S2,750,000 OTHER: 51R $250,000 A AUTOMOBILE LIABILITY ISA H11429178 03/31/2026 03/31/2027 COMBINED SINGLE LIMIT (Ea accident) 510, 000, 000 X ANY AUTO BODILY INJURY ( Per person) OWNED S SCHEDULED A NON -OWNED AUTOS ONLY PROPERTY DAMAGE {Per accident} E X UMBRELLA LIAR X OCCUR x0QG72514816006 03/31/2026 03/31/2027 EACH OCCURRENCE 510,000,000 EXCESS LIAB CLAIMS -MADE Umil - Auto AGGREGATE $10,000,000 DSO X RETENTION 325 000 B WORKERS COMPENSATION ANO EMPLOYERS' LIABILITY WLRC72807157 03/31/2026 03/31/2027 x PER STATUTE OTH• ER C Y!N ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICERMEMBER N 1 1 NfA AOS SCFC72807170 03/31/2026 03/31/2027 E.L. EACH ACCIDENT S1,000,000 EXCLUDED? (Mandatory in NH) WI E.L. DISEASE -EA EMPLOYEE S1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT S1,000,000 D E&O - Professional Liability - Excess CSHLC2601663 Ex Prof (Claim Made)/Ex GL SIR applies per policy terns 03/31/2026 & condi 03/31/2027 ions Per Occ/Agq SIR - Ex Prof SIR - Ex GL S15,000,000 S10,000,000 S10,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it 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 I5 GRANTED IN FAVOR OF CERTIFICATE HOLDER IN ACCORDANCE WITH THE POLICY PROVISIONS OF THE GENERAL LIABILITY POLICY. CERTIFICATE HOLDER CANCELLATION THE CITY OF GILROY ITS OFFICERS AND EMPLOYEES ATTN CHIEF FOSTER ROSSANA STREET GILROY CA 95020 USA 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 C 49f2..x0�,,.7.7351 ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Holder Identifier : 570118657623 Certificate No AGENCY CUSTOMER ID: 570000073826 LOC #: ADDITIONAL REMARKS SCHEDULE Page of _ AGENCY Aon Risk Services Central, Inc. NAMED INSURED American Medical Response Inc POLICY NUMBER See Certificate Number: 570118657623 CARRIER see Certificate Number: 570118657623 NAIC CODE EFFECTIVEDATF: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER INSURER INSURER INSURER policy below does not include limn information, refer to the corresponding policy on the ACORDADDITIONAL POLICIES if a certificate form for policy limits. INSR Lilt TYPE OF INSURANCE ADDL INSD SL'IIR 1VVD POLICY NUMBER POLICY EFFECTIVE HATE (ilM/DD/YYVY) POLICY EXPIRATION DATE IMHI/DD/YYYY} LIMITS WORKERS COMPENSATION A N/A wcuc72807194 OH SIR applies per policy terms 03/31/2026 & conditions 03/31/2027 OTHER D E&o - Professional Liability - Excess C5HLC2601663 Ex Prof(claim Made)/Ex GI SIR applies per policy terms 03/31/2026 & conditions 03/31/2027 Sex Ws Per $10,000,000 sex Mis Agg $10,000,000 ACORD 101 (200B/01) The ACORD name and logo are registered marks al ACORD 02008 ACOHD CORPORATION. All rights reserved. AGENCY CUSTOMER ID: 570000073826 LOC #: ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY Aon Risk Services central, Inc. POLICY NUMBER See Certificate Number: 570118657623 CARRIER See Certificate Number: 570118657623 NAIC CODE NAMED INSURED American Medical Response Inc EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance XS GL/E&o Carriers Dale 30.00% Chaucer 6.66% Chubb 16.66% MedPro 10.00% Hamilton 8.18% ACT 28.50% Total: 100.00% ACORD 101 (200BI01 ) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved.