RIVERSIDE MISSION PEDIATRIC MEDICAL GROUP INC

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RIVEMIS -01 MBIAFORE ACORN' I CERTIFICATE OF LIABILITY INSURANCE aarE {MMIaomYYt 313!2016 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 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 License # 0757776 NAME: Kristie Koehrer HUB International Insurance Services Inc. IAICC PHONE Eat .(95i 788 -8500 (c Mal: 951 788 -8502 P. 0. Box 5345 oRERiverside, CA 92517 E-MAIL INSURED Riverside Mission Pediatric Medical Group, Inc. P.Q. Box 9270 Redlands, CA 92375 -2470 INSURER A: AMCO Insurance Company 19100 INSURER B. Preferred Employers Insurance Company 10900 INSURER C: COVERAGES CERTIFICATE NUMBER: 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. !TR TYPE OF INSURANCE 1NSD wvo POLICY NUMBER (MMIDDIYYYYI I POLICY LIMITS A I X I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,00 LnCLAIMS -MADE X OCCUR X ACP7845529238 03/0112016 0 3101 1201 7 PREMISES IEs ocwrrencel $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT JECT AUTOMOBILE LIABILITY A ANY AUTO AUTOS AUTOS NON -OWNED X HIRED AUTOS X AUTOS A H EXCESS LIABAB H CLAIMS EACH OCCURRENCE I $ 1,000,000 B 0310112016 0310112017 AGGREGATE Is 1,000,000 Is WORKERS COMPENSATION X TH- AND EMPLOYERS' LIABILITY STATUTE ER B ANY PROPRIETORIPARTNERIEXECUTIVE YIN CMN157081 -2 12/0112015 12/0112016 E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? EVI N I A (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ if DESCRIPTION OF Ounder PERATIONS below E.L. DISEASE - POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached it more space Is required) City of Riverside Is Additional Insured in regards to the General Liability policy per the attached endorsement form P80006 11114. CERTIFICATE HOLDER CANCELLATION City of Riverside Risk Management 3900 Main Street Riverside, CA 92522 i 1 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE %MLL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE @ 1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and [ago are registered marks of ACORD MED EXP (Any am person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMPIOP AGG S S 03101/2016 03101/2017 COMBINED SINGLE LIMIT S Ea accdent BODILY INJURY (Per person) S BODILY INJURY (Per eccidentl S PROPERTY D AG $ Per accident a EACH OCCURRENCE I $ 1,000,000 B 0310112016 0310112017 AGGREGATE Is 1,000,000 Is WORKERS COMPENSATION X TH- AND EMPLOYERS' LIABILITY STATUTE ER B ANY PROPRIETORIPARTNERIEXECUTIVE YIN CMN157081 -2 12/0112015 12/0112016 E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? EVI N I A (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ if DESCRIPTION OF Ounder PERATIONS below E.L. DISEASE - POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached it more space Is required) City of Riverside Is Additional Insured in regards to the General Liability policy per the attached endorsement form P80006 11114. CERTIFICATE HOLDER CANCELLATION City of Riverside Risk Management 3900 Main Street Riverside, CA 92522 i 1 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE %MLL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE @ 1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and [ago are registered marks of ACORD