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HomeMy WebLinkAboutCOI - Global Medical Response, Inc. - Expires 2023-09-01ACOAZ. O'''' ��- CERTIFICATE OF AVIATION LIABILITY INSURANCE DATE(MM YY) oa/1 s/2022 zozz 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 Aon Risk Services Central, Inc. Phi 1 adel phi a PA Offi Ce 100 North 18th Street 15th Fri 00r Philadelphia PA 19103 USA CONTACT NAME: PHONE (866) 283-7122 FAX (800) 363-0105 (NC. No. Cut): (A/C. No.): E-MAIL ADDRESS: PRODUCER 570000073826 CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE % NAIC # INSURED Global Medical Response, Inc.' "see Addendum for complete Named Insured 6363 5. Fiddlers Green Circle Suite 1400 Greenwood village Co 80111 USA INSURER A: Starr Indemnity & Liability Company 26 38318 INSURER B: INSURERC: INSURERD: INSURER E: INSURER F: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PO_ICY 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 RTIFICATE NUMBER: 570094961713 REVISION NUMBER: Holder Identifier : INSURER LETTER A POLICY NUMBER SASICOM6003512212 EFFECTIVE DATE 09/01/2022 EXPIRATION DATE 09/01/2023 ADDITIONAL INSURED ? (Y/N) Y SUBROGATION WAIVED ? (Y/N) N IIICertificate No : 570094961713 COVERAGE OPTIONS LIMIT APPLIES TO LIMIT APPLIES TO PREMISES LIABILITY X CSL $50,000,000 El EA PER EA OCC $2.000,000 pD PREMISES MEDICAL PAYMENTS L--1 $25,000 EA PER EA OCC PRODUCTS LIABILITY SALE OF FUEL & OIL EXTENDED $50,000,000 El EA PER EA OCC $50,000,000 AGGR COMPLETED OPERATIONS LIABILITY EXTENDED Wind U IIncI in Products Indin Products Ind in Products BI EA PER EA OCC Inc! in Products AGGR HANGARKEEPERS LEGAL LIABILITY INCLUDING TAXI IN FLIGHT $50,000,000 EA AIRCRAFT $50,000,000 EA OCC - FIRE LEGAL LIABILITY $2,000,000 ANY ONE FIRE PERSONAL INJURY LIABILITY EA OCC $25,000,000 AGGR ADVERTISING LIABILITY X Incl in Pers Injury Ind in Pers Injury EA OCC Inc! in Pers Injury AGGR CONTRACTUAL LIABILITY INCLUDED EXCLUDED COVERAGE OPTIONS LIMIT APPLIES TO LIMIT APPLIES TO CODE DESCRIPTION HangerKeeper Deductible X HangerKeeper Deductible $25,000 Ded Ea Aircraft IBIS ate,_ �®e �a DESCRIPTION OF OPERATIONS / REMARKS (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) - The certificate Holder is included as an Additional Insured on liability coverage(s), but only with respect to operations of the Named Insured. - In the event of cancellation of any policy described above, the insurer will attempt to mail 30 days (10 days for non-payment of premium and 7 days with respect to war policy provisions) written notice to the Certificate Holder prior to the effective date of cancellation. However, failure to do so will not impose duty or liability upon the insurer, its agents or representatives, nor will it dela CERTIFICATE HOLDER City of Gilroy 7351 Rosanna Gilroy CA 95020 USA SEP 12022 GILROY CITY CLERK'S OFFICE CANCELLATION 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 t--X.Fv�l9d c�'�!!Q/G 5fi24e�C4'l C�Y�e�/ 9SEi © 2009, 2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Qua ar ACORD 20 (2016/03) PRIVATE HANGAR LIABILITY COVERAGES PRODUCER CUSTOMER ID: 570000073826 INSURER LETTER POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE ADDITIONAL INSURED ? (Y/N) SUBROGATION WAIVED ? (Y/N) COVERAGE OPTIONS LIMIT APPLIES TO LIMIT APPLIES TO HANGARKEEPERS LEGAL LIABILITY INCLUDING TAXI ' I L_ IN FLIGHT EA AIRCRAFT EA OCC COVERAGE OPTIONS LIMIT APPLIES TO LIMIT APPLIES TO CODE DESCRIPTION VERAGES INSURER LETTER POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE ADDITIONAL INSURED ? (Y/N) SUBROGATION WAIVED ? (YIN) COVERAGE OPTIONS LIMIT APPLIES TO LIMIT APPLIES TO PRODUCTS LIABILITY INCL COMP OPS EXCL COMP OPS INCL SPACECRAFT EXCL SPACECRAFT EA OCC AGGR GROUNDING LIABILITY EA OCC AGGR FOREIGN MILITARY AIRCRAFT PRODUCTS INCLUDED -- COVERAGE OPTIONS LIMIT APPLIES TO LIMIT APPLIES TO CODE DESCRIPTION LINE OF BUSINESS INSURER LETTER POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE ADDITIONAL INSURED ? (Y/N) SUBROGATION WAIVED ? (Y/N) COVERAGE OPTIONS LIMIT APPLIES TO LIMIT APPLIES TO CODE DESCRIPTION LINE OF BUSINESS INSURER LETTER POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE ADDITIONAL INSURED ? (Y/N) SUBROGATION WAIVED ? (Y/N) COVERAGE OPTIONS LIMIT APPLIES TO LIMIT APPLIES TO CODE DESCRIPTION ACORD 20 (2016/03) AGENCY CUSTOMER ID: 570000073826 LOC #: ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY Aon Risk services Central, Inc. NAMED INSURED Global Medical Response, Inc.* POLICY NUMBER See Certificate Number: 570094961713 CARRIER See Certificate Number: 570094961713 NAIC CODE EFFECTIVE DATE ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 20 FORM TITLE: Certificate of Aviation Liability Insurance Insurer (1) Starr Indemnity and Liability Ins Co Through Starr Aviation Agency, Inc (Lead 26%) (2) Air Centurion Insurance Services, LLC on Behalf of Falls Lake National Insurance Company (22.5%) (3) Allianz Global Risks us Insurance Company Through Allianz Global Corporate and specialty (19.5%) (4) National union Fire Insurance Co. of Pittsburgh, PA Through AIG Aerospace Insurance services (10%) (5) Great American Insurance Company (5%) (6) Endurance American Insurance Company (W. Brown and Associates) (4.5%) (7) Lloyd's of London Aon UK (12.5%) nnnnnn nd ns nnn2no nn1191 P ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. ACORO® AGENCY CUSTOMER ID: 570000073826 LOC #: ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY Aon Risk Services Central, Inc. NAMED INSURED Global Medical Response, Inc.* POLICY NUMBER See Certificate Number: 570094961713 CARRIER See Certificate Number: 570094961713 NAIC CODE EFFECTIVE DATE ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 20 FORM TITLE: Certificate of Aviation Liability Insurance other Coverages/Conditions/Remarks ANY INSURANCE EVIDENCED HEREIN THAT IS EXTENDED BEYOND COVERAGE PROVIDED TO THE NAMED INSURED SHALL NOT APPLY TO, AND NO PERSON OR ORGANIZATION TO WHOM SUCH EXTENDED COVERAGE APPLIES SHALL BE INSURED FOR BODILY INJURY OR PROPERTY DAMAGE WHICH ARISES FROM THE DESIGN, MANUFACTURE, MODIFICATION, REPAIR, SALE, OR SERVICING OF THE AIRCRAFT, AIRCRAFT PARTS, OR ANY OTHER PRODUCT BY THAT PERSON OR ORGANIZATION. THIS CERTIFICATE DOES NOT CHANGE IN ANY WAY THE ACTUAL COVERAGES PROVIDED BY THE POLICY(IES) SPECIFIED ABOVE. ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. AGENCY CUSTOMER ID: 570000073826 LOC #: ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY Aon Risk Services Central, Inc. NAMED INSURED Global Medical Response, Inc.* POLICY NUMBER See Certificate Number: 570094961713 CARRIER See Certificate Number: 570094961713 NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 20 FORM TITLE: Certificate of Aviation Liability Insurance Named Insured GLOBAL MEDICAL RESPONSE, INC. (FKA AIR MEDICAL GROUP HOLDINGS, INC.), AIR MEDICAL GROUP HOLDINGS, LLC AND AS MORE FULLY ENDORSED, INCLUDING REACH MEDICAL HOLDINGS, LLC REACH AIR MEDICAL SERVICES, LLC; AIR ANGELS, LLC, REACH HOLDINGS, INC, DBA REACH AIR MEDICAL SERVICES DBA REACH AIR MEDICAL SERVICES DBA METHODIST AIR CARE, CAL -ORE LIFE FLIGHT, LLC, EXPEDITION HELICOPTERS, INC., CALSTAR AIR MEDICAL SERVICES LLC, ARCATA-MAD RIVER AMBULANCE LLC AND AIRMEDCARE NETWORK. ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. NOTICE: LEAD POLICY NO. SASICOM60035122-12 ALL PREVIOUSLY ISSUED ENDORSEMENTS FROM THE PRIOR YEAR ARE STILL ACTIVE AND VALID AND CAN BE APPLIED TO THIS RENEWAL CERTIFICATE UNLESS OTHERWISE SPECIFIED. Empower Results°