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HomeMy WebLinkAboutCOI - Global Medical Response, Inc. - Expires 2022-09-01I ® CERTIFICATE OF AVIATION LIABILITY INSURANCE DATE(MM/DDYYYY} 08/27rz021 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: the certificate holder Is an ADDITIONAL INSURE15, the pol cy es must have ADDITIONAL RED provisions or be en orsed. 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. Philadelphia PA office one Liberty Place 1650 Market street CONTACT NAME: PHONE (866) 283-7122 FAX (800) 363-0105 (A/C. No. Ext): A/C. No.): ADDRIESS: suite 1000 Philadelphia PA 19103 USA PR D cER 570000073826 CUSTOMER ID 0. INSURER(S) AFFORDING COVERAGE % NAIC # INSURED Global Medical Response, inc.* INSURER A: Starr Indemnity & Liability Company 30 38318 INSURER B: *see Addendum for complete Named Insured 6363 S. Fiddlers Green Circle suite 1400 INSURER C: INSURER D: Greenwood village Co 80111 USA INSURER E: INSURER F: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LIST079EEOW-WE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PO JCY 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, -EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as re nested AIRPORT & FBO LIA131LITY COVERAGES CERTIFICATE NUMBER: 57008955Z11 REVISION NUMBER: INSURER LETTER A POLICY NUMBER SASICOM8003512111 EFFECTIVE DATE 09/01/2021 EXPIRATION DATE 09/01/2022 ADDITIONAL INSURED ? (YIN) Y SUBROGATION WAIVED ? (YIN) N COVERAGE OPTIONS LIMIT APPLIES TO LIMIT APPLIES TO PREMISES LIABILITY X CSL $50,000,000 81 EA PER EA OCC $2,000.000 PD PREMISES MEDICAL PAYMENTS H$25,000 EA PER EA OCC PRODUCTS LIABILITY SA F L EXTENDED S50,000,000 EA OCC 0, COMPLETED OPERATIONS LIABILITY EXTENDED X Ind in Products Ind in Products Ind in Products 81 EA PER EA OCC Ind in Products AGGR HANGARKEEPERS LEGAL LIABILITY INCLUDING TAXI IN FLIGHT $50.000,000 EAAIRCRAFT $50,000,000 EA OCC FIRE LEGAL LIABILITY S2,000,000 ANY ONE FIRE PERSONAL INJURY LIABILITY EA OCC $25.000,000 AGGR ADVERTISING LIABILITY X Ind in Pers Injury Ind in Pers Injury EA OCC Ind in Pers Injury AGGR CONTRACTUAL LIABILITY INCLUDED EXCLUDED COVERAGE OPTIONS LIMIT APPLIES TO LIMIT APPLIES TO CODE DESCRIPTION HangerKeeper Deductible X HangerKeeper Deductible S25,000 Ded Ea Aircraft 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 delay cancellation. CERTIFICATE HOLDER MR City of Gilroy 7351 Rosanna Gilroy CA 95020 USA CANCELLATION N LID LO OD OD 0 0 LO O Z d 0 d't SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Z� AUTHORIZED REPRESENTATIVE J�J� � � � ✓ 7�G1 C 2009, 2016 ACC ACORD 20 (2016/03) The ACORD name and logo are registered marks of ACORD ghts reserved. PRIVATE HANGAR LIABILITY COVERAGES PRODUCER CUSTOMER ID: 570000073826 INSURER LETTER POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE ADDITIONAL INSURED ? (YIN) SUBROGATION WAIVED ? (YIN) COVERAGE OPTIONS LIMIT APPLIES TO LIMIT APPLIES TO HANGARKEEPERS LEGAL LIABILITY INCLUDING TAXI Li IN FLIGHT EAAIRCRAFT EA OCC COVERAGE OPTIONS LIMIT APPLIES TO LIMIT APPLIES TO CODE DESCRIPTION AVIAI IUIV F'KUUUG 15 LIABILITY GUVERAGES INSURER LETTER POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE ADDITIONAL INSURED ? (YIN) SUBROGATION WAIVED ? (YIN) COVERAGE OPTIONS LIMIT APPLIES TO LIMIT APPLIES TO PRODUCTS LIABILITYId 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 U 1 P7CK LpUV CKAUr-b LINE OF BUSINESS INSURER LETTER POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE ADDITIONAL INSURED ? (YIN) SUBROGATION WAIVED ? (YIN) COVERAGE OPTIONS LIMIT APPLIES TO LIMIT APPLIES TO CODE DESCRIPTION U I HtK t:UVtKAtjtS LINE OF BUSINESS INSURER LETTER I POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE ADDITIONAL INSURED ? (YIN) SUBROGATION WAIVED ? (YIN) COVERAGE OPTIONS LIMIT APPLIES TO LIMIT APPLIES TO CODE DESCRIPTION AUUKU lU (1U96/U3) AGENCY CUSTOMER ID: 570000073826 LOC #: ACORD® ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY Aon Risk services Central, Inc. NAMED INSURED Global Medical Response, Inc.* POLICY NUMBER see certificate Number: 5700889S5271 CARRIER See certificate Number: 570088955271 NAIC CODE EFFECTIVE DATE: 1 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 30%) (2) Air Centurion Insurance services, LLC on Behalf of Falls Lake National Insurance company (26.5%) (3) Allianz Global Risks us Insurance company Through Allianz Global Corporate and specialty (22.5%) (4) National union Fire Insurance co. of Pittsburgh, PA Through AIG Aerospace Insurance services (15%) (5) Great American Insurance company (6%) Ai n. ACORD 101 (2008/01) 0 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000073826 ` LOC #: AC RORO D® ADDITIONAL REMARKS SCHEDULE Page _ of _ 1GENCY NAMED INSURED kon Risk Services Central, Inc. Global Medical Response, Inc.* )OLICY NUMBER ;ee Certificate Number: 570088955271 ;ARRIER NAIC CODE See Certificate Number: 570088955271 1 EFFECTIVE DATE: ADDITIONAL REMARKS ITHIS 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) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000073826 LOC #: ACd OR `� ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY Aon Risk Services Central, Inc. NAMED INSURED Global Medical Response, Inc.' POLICY NUMBER See Certificate Number: 570088955271 CARRIER See Certificate Number: 570088955271 NAIC CODE EFFECTIVE DATE: 1 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 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD