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Francine R. <br />Digitally signed by Francine R. <br />Villareal <br />Villareal <br />Date �Wl MneiF�i U-mv <br />ACORO° CERTIFICATE OF LIABILITY INSURANCE <br />1 <br />DATE (MMIDDIYWY) <br />2/16/2022 <br />2/15/2021 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <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), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions <br />or be endorsed. <br />If SUBROGATION IS WAIVED, 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 />CONT <br />NAMEACT <br />9110 E Union Avenue <br />PHONE FAX <br />Suite 100 <br />Ext : A/C, Na <br />E-MAIL <br />Denver CO 80237 <br />ADDRESS: <br />(303) 414-6000 <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />INSURER A: Arch Specialty Insurance Company <br />21 199 <br />INSURED WellDyneRX, LLC <br />1477414 <br />INSURER B : Zurich American Insurance Company <br />16535 <br />500 Eagles Landing Drive <br />INSURER C : ACE American Insurance Company <br />22667 <br />Lakeland, FL 33810 <br />INSURER D : Berkley Insurance Company <br />32603 <br />INSURER E : <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: 14516082 REVISION NUMBER: <br />XXXXXXX <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 <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />INSD <br />SUBR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MMIDDIYYYY <br />POLICY EXP <br />MMIDD/YYYY <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />N <br />N <br />FLP006017704 <br />2/16/2021 <br />2/16/2022 <br />EACH OCCURRENCE <br />$ 1,000,000 <br />CLAIMS -MADE � OCCUR <br />DAMAGE TO RENTED <br />PREMISES Ea occurrence <br />$ 100,000 <br />IVIED EXP (Any one person) <br />$ 5,000 <br />PERSONAL & ADV INJURY <br />$ 1,000,000 <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$ 3,000,000 <br />POLICY ❑JECT PRO ❑ LOC <br />PRODUCTS - COMP/OP AGG <br />$ 3,000,000 <br />$ <br />OTHER: <br />A <br />AUTOMOBILE <br />LIABILITY <br />N <br />N <br />FLP006017704 <br />2/16/2021 <br />2/16/2022 <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$ 1,000,000 <br />BODILY INJURY (Per person) <br />$ XXXXXXX <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY (Per accident) <br />$ XXXXXXX <br />X <br />PROPERTY DAMAGE <br />Per accident <br />$ XXXXXXX <br />HIRED X NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />$XXXXXXX <br />A <br />X <br />UMBRELLA LIAB <br />OCCUR <br />N <br />N <br />FLP006017704 <br />2/16/2021 <br />2/16/2022 <br />EACH OCCURRENCE <br />$ 10,000,000 <br />A <br />EXCESS LIAB <br />CLAIMS -MADE <br />Retro Date: 2/16/2020 <br />X <br />AGGREGATE <br />$ 10,000,000 <br />DED RETENTION $ <br />1 <br />$ XXXXXXX <br />1 <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH) <br />N I A <br />N <br />WC014390904 <br />2/16/2021 <br />2/16/2022 <br />PER OTH- <br />X STATUTE I I ER <br />E.L. EACH ACCIDENT <br />E.L. DISEASE - EA EMPLOYEE <br />$ 1,000,000 <br />$ 1,000,000 <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$ 1,000,000 <br />A <br />Pharmacy Prof. Liab. <br />N <br />N <br />FLP006017704 <br />2/16/2021 <br />2/16/2022 <br />$1M/$3M Retro Date: 2/16/2020 <br />C <br />PBM E&O Liab. <br />MSPG72508130001 <br />2/16/2021 <br />2/16/2022 <br />Limit: $5M/Ret $250K <br />D <br />Crime <br />BCCR4500242324 <br />2/16/2021 <br />2/16/2022 <br />Limit: $2M per Occ. <br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />Per Agreement Master Agreement A-2007-278 and current agreement A-20180-131-01 with the City of Santa Ana, Proof of Workers Compensation Coverage. <br />14516082 <br />City of Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza <br />Santa Ana CA 92701 <br />ACORD 25 (2016/03) <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />]Z181l Mwagmerit; DR isiun <br />• z REVIEWED & APPROVED BY. - <br />Cc, 1988-20'.d <br />The ACORD name and logo are registered marks of ACORD ` Risk Management Analyst <br />