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DocuSign Envelope ID: 2FEC7950-846A-4427-8D35-5C288A6B81A1 WAWA CYNTHIA INSURANCE AGENCY <br />(626)810-5556 <br />Nationwide <br />360 Clinic <br />Commercial Insurance Application <br />Quote Number: ACP 3009934033 <br />Effective: 01/18/2021 to 01/18/2022 <br />Applicant Pro£de <br />Has any policy been cancelled or non -renewed within the past three years? ....................................... O Yes W No <br />Operations <br />Does the applicant have subsidiaries?.................................................................... O Yes 13 No <br />How many years has the applicant been in this line of work? 5 years <br />Year Business Started 2020 <br />Describe the applicant's operations, including a description by premises. <br />At 360, our mission is simple - provide, empower, inform, and treat We are a dedicated group of caregivers, <br />physicians, providers and community advocates that want to serve with a vision to care for all. We believe <br />that all community members, from our vulnerable elderly and immunocompromised friends and family, to <br />our healthy individuals, deserve access to their health information. In threes of uncertainty, knowledge is <br />peace.Our super -site testing centers are designed for all - with ease of access, rapid results, and humane - <br />centered care. We believe health is a human right, and at 360 Clinic, your health is our priority. Real time <br />results for under -served community members means we start from the ground up. That?s why we believe in <br />complete care, a circle of community, and a caring core.Welcome to 360 Clinic. <br />Gross Annual Receipts $ 100,000 <br />Website Address https://www.360clinic.md/ <br />What percent of sales are derived from website sales? No website sales <br />Select the applicant's risk management practices: <br />® Drug testing <br />® Return to work program <br />® Documented hiring practices (employment application, references, driving records, etc.) <br />® Regular safety meetings <br />• Employee training programs <br />Do employees use their personal auto for the delivery of food or other goods? .................................... ❑ Yes <br />Has the applicant had prior insurance with standard markets for all lines of business included on the quote? ............. ® Yes <br />Carrier Hartford <br />Type of Risk: <br />Named Insureds <br />360 Clinic <br />Entity Type: Corporation <br />Addresses <br />1850 S West St <br />Anaheim, CA 92802 - 3407 <br />Orange <br />Address Type: Primary, Mailing, Billing <br />Account Contacts <br />X No <br />❑ No <br />1100 Locust St., Dept. 1100 Page 3 Des Moines,lA 50391-1100 <br />