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HomeMy WebLinkAboutCOI - American Medical Response, Inc. - Expires 2026-03-31 Cert No. 570111618513Holder Identifier : 7777777707070700077763616065553330763736464124677407640025552725102071662775364323300734067771247673207742415132654130073440557122743100772603155403475407366217750254112077727252025773110777777707000707007 6666666606060600062606466204446200620002606226000206200024040062202062220060402602200620022426224020006002004262260022062200260622402000622200604200240006220044200660060066646062240664440666666606000606006Certificate No :570111618513CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 03/25/2025 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). 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. PRODUCER Aon Risk Services Central, Inc. Philadelphia PA Office 100 North 18th Street 16th Floor Philadelphia PA 19103 USA PHONE (A/C. No. Ext): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # (866) 283-7122 INSURED 22667ACE American Insurance CompanyINSURER A: 20702ACE Fire Underwriters Insurance Co.INSURER B: 43575Indemnity Insurance Co of North AmericaINSURER C: 15792Underwriters At Lloyds LondonINSURER D: 20699ACE Property & Casualty Insurance Co.INSURER E: INSURER F: FAX (A/C. No.):(800) 363-0105 CONTACT NAME: American Medical Response Inc 4400 State Hwy 121, St 700 Lewisville TX 75056 USA COVERAGES CERTIFICATE NUMBER:570111618513 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 POLICY EXP (MM/DD/YYYY) POLICY EFF (MM/DD/YYYY) SUBR WVD INSR LTR ADDL INSD POLICY NUMBER TYPE OF INSURANCE LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR POLICY LOC EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG X X X GEN'L AGGREGATE LIMIT APPLIES PER: $2,750,000 $100,000 $10,000 $2,750,000 $5,000,000 $2,750,000 $250,000SIR A 03/31/2025 03/31/2026 SIR applies per policy terms & conditions XSLG48960455 PRO- JECT OTHER: AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY SCHEDULED AUTOS HIRED AUTOS ONLY NON-OWNED AUTOS ONLY BODILY INJURY ( Per person) PROPERTY DAMAGE (Per accident) X X BODILY INJURY (Per accident) $10,000,000A03/31/2025 03/31/2026 Comp Ded $2500 COMBINED SINGLE LIMIT (Ea accident) ISA H10817614 Coll Ded $2500X EXCESS LIAB X OCCUR CLAIMS-MADE AGGREGATE EACH OCCURRENCE DED $10,000,000 $10,000,000 03/31/2025 Umb - Auto UMBRELLA LIABE 03/31/2026XCQG72514816005 RETENTION X E.L. DISEASE-EA EMPLOYEE E.L. DISEASE-POLICY LIMIT E.L. EACH ACCIDENT $1,000,000 X OTH- ER PER STATUTEC03/31/2025 03/31/2026 AOS SCFC72631158B 03/31/2025 03/31/2026 $1,000,000 Y / N (Mandatory in NH) ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED?N / AN WI WORKERS COMPENSATION AND EMPLOYERS' LIABILITY If yes, describe under DESCRIPTION OF OPERATIONS below $1,000,000 WLRC72631110 Per Occ/AggCSHLC250166303/31/2025 03/31/2026 Ex Prof(Claim Made)/Ex GL $10,000,000SIR - Ex Prof SIR - Ex GL $3,000,000 E&O - Professional Liability - Excess D SIR applies per policy terms & conditions $15,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: 7321-A CHURCH STREET, GILROY, CA. CITY OF GILROY IS INCLUDED AS ADDITIONAL INSURED IN ACCORDANCE WITH THE POLICY PROVISIONS OF THE GENERAL LIABILITY, EXCESS LIABILITY & AUTOMOBILE LIABILITY POLICIES. CANCELLATIONCERTIFICATE HOLDER AUTHORIZED REPRESENTATIVECITY OF GILROY ATTN: PATRICIA HUTH 7351 ROSANNA ST. GILROY CA 95020-6141 USA ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AGENCY CUSTOMER ID: ADDITIONAL REMARKS SCHEDULE LOC #: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:ACORD 25 FORM TITLE:Certificate of Liability Insurance EFFECTIVE DATE: CARRIER NAIC CODE POLICY NUMBER NAMED INSUREDAGENCY See Certificate Number: See Certificate Number: 570111618513 570111618513 Aon Risk Services Central, Inc. 570000073826 ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. INSURER INSURER INSURER INSURER INSURER(S) AFFORDING COVERAGE Page _ of _ NAIC # American Medical Response Inc TYPE OF INSURANCE POLICY NUMBER LIMITS WORKERS COMPENSATION A WCUC72631195 03/31/2025 03/31/2026 OH N/A ADDL INSD INSR LTR SUBR WVD POLICY EFFECTIVE DATE (MM/DD/YYYY) POLICY EXPIRATION DATE (MM/DD/YYYY) SIR applies per policy terms & conditions ACORD 101 (2008/01)© 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD