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CERTIFICATE OF LIABILITY INSURANCE o2/13/2020 <br />zn <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS <br />UPON THE CERTIFICATE HOLDER. THIS <br />ERTIF HOLDER. T <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), <br />AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED <br />provisions or be endorsed. If SUBROGATION IS WANED, subject to the terms and conditions of the policy, certain policies may require an endorsement. <br />A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER Lockton Companies <br />CONTACT <br />8110 E Union Avenue <br />NAME: <br />PHONE FAX <br />Suite 700 <br />E t' No: <br />Denver CO 80237 <br />ADDRESS: <br />(303)414-6000 <br />INSURER$ AFFORDING COVERAGE <br />me# <br />INSURER A: ATCh S eC"I Insurance Company an <br />21199 <br />INSURED WellDyneRX, LLC. <br />1424829 <br />INSURER B: Zurich American Insurance Company <br />16535 <br />500 Eagles Landing Drive <br />INSURER c :National UnionFire Ins Co Pitts. PA <br />19445 <br />Lakeland, FL 33810 <br />INSURER D: Berkley Insurance Company <br />32603 <br />INSURER E : <br />COVFRA(:FR reurrnrnrc un.....-.,. <br />NSURER F: <br />NC:VI6IUIN NUMBER: XX)DCXXX <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR AD S BR <br />LTR TYPEOFINSURANCE VIV POLICY NUMBER MMADWYYYY MM(DDIIYYYY LIMITS <br />A <br />)( <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE W OCCUR <br />N <br />N <br />FLP006017703 <br />2/162020 <br />2/16/2021 <br />EACH OCCURRENCE <br />$ 1000 <br />000000 <br />PREMI-ORWSES oc yErrence <br />$ 100,000 <br />MED EXP (Any one emn) <br />$ 5,000 <br />PERSONAL a ADV INJURY <br />S 1 000 000 <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER: <br />POLICY ❑ jEC LOC <br />OTHER: <br />GENERAL AGGREGATE <br />s 3,000,000 <br />PRODUCTS-COMP/OPAGG <br />s 3000000 <br />S <br />A <br />AUTOMOBILE <br />X <br />LIABILITY <br />ANY AUTO <br />OWNECHED <br />AUTOS? <br />UTOS ONLY F:jAUTOSULEO NON_U NEBODILY <br />HIRED ONLY X AUTOS ONLP <br />N <br />N <br />FLP006017703 <br />2/162020 <br />2/I62021 <br />COMBINED SINGLE OMIT <br />Eeaccidei <br />s 1000000 <br />BODILY INJURY(Perperson) <br />$ XXXX)M <br />INJURY(Per accident <br />$ X)OC XXX <br />PROPERTY DAMAGE <br />er accla 1 <br />$ XXXXXX <br />S X 5555ff <br />A <br />B <br />X <br />UMBRELLA LIAB <br />EXCESS LIAR <br />X <br />OCCUR <br />CLAIMS -MACE <br />N <br />NIA <br />N <br />N <br />FLP006017703 <br />WC0143909D3 <br />2/162020 <br />2/162020 <br />i(i6 021 <br />2/16/2021 <br />EACH OCCURRENCE <br />$ 10,000A0 <br />AGGREGATE <br />$ 10 000 000 <br />OEO RETENTION$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETORMARTNER/EXECU T W E <br />OFFICERIMEMSER EXCLUDED? ENE <br />(Mandatory In NH) <br />ayes, describe uMer <br />X ASTUTE ORH <br />$ XXXXJ{){)C <br />EL EACH ACCIDENT <br />$ 1000000 <br />E.1- DISEASE - EA EMPLOYE <br />$ 1000 000 <br />A <br />C <br />D <br />DESCRIPTION OF OPERATIONS below <br />Pharmacy Prof,Liab. <br />PBM E&O Liab• <br />Crime <br />N <br />N <br />FLP006017703 <br />039869656 <br />BCCR4500242323 <br />7J162020 <br />2/I62020 <br />2/162020 <br />216/2021 <br />2/16/2021 <br />2/162021 <br />EA.OISFASE- POLICYUMn $ 1000000 <br />$IM/$3M <br />Limit: $SM/Ret $250K <br />Limit: $2M per Oce. <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101. Additional Remarks Schedule, may be aaacbed R more space Is required) <br />ByVttiEWiskMD & APPRpOVEITD <br />rconnrnrc unr nco _ r, __..___ <br />16191579 <br />City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Risk Management Division THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />20 Civic Center Plaza, M-28 ACCORDANCE WITH THE POLICY PROVISIONS. <br />P.O. Box 1988 <br />REPRESENTATIVE <br />AUTHORIZED REPRESE <br />Santa Ana, CA 92702 \�f � �„ ✓,.. � /�f`�/s,�J.+ <br />reserved. <br />,------- 1 111w ..,mu ,mitre anu logo are registered marks of ACORD <br />