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Francine R. Digitally signed by Francine R. Villareal � ® Villareal ACORO CERTIFICATE OF LIABILITY INSURANCE `/ DDMRNMMDA'YYY) 12/17/2021 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 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). PRODUCER Dodge Insurance Services, Inc. DBA Arroyo Insurance Services 3480 Torrance Blvd., Suite 301 CONTACT NAME: Nora Vazquez PHONE FAX 310-356-8207 ac No:310-356-1825 ADDRESS: norav@arroyoins.com Torrance CA 90503 INSURERS AFFORDING COVERAGE NAICIr INSURER A: National Fire & Marine Ins. Co 20079 INSURED INDUS-1 Industrial Medical Support, Inc. 3320 E. Airport Way INSURER B INSURER C: INSURER D: Long Beach CA 90806 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1519681559 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. INSR LTR OF INSURANCE ADDLTYPE JIM SUBR POLICY NUMBER MMIOUYEFF MWPOLICY EXP DO LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR Y Y HN033337 3/15/2021 3/15/2022 EACH OCCURRENCE $1,000,000 -DAMAGETO PREMISESSEa occurrence) $50,000 MED EXP (Art, one person) $ 5,000 PERSONAL &ADV INJURY $1,000,000 AGGREGATE LIMIT APPLI ES PER: GENERAL AGGREGATE $3,000,000 GEN'L POLICY ❑ JECOT [XI LOG PRODUCTS-COMP/OP AGO $3.000.000 S OTHER: A AUTOMOBILE LIABILITY HN033337 3/15/2021 3/15/2022 COMBINED SINGLE LIMIT Ea acWtlenl $1,000.000 BODILY INJURY (Per person) $ AUTO JANY OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X HIRED P1 NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ A UMBRELLA LIAR X OCCUR EN033337 3/15/2021 3/15/2022 EACH OCCURRENCE $51000,000 AGGREGATE $5,000,000 X EXCESS LIAB CLAIMS -MADE LIED I X I RETENTION$ D $ WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY YIN PER OTH- STATUTE I I ER E.L. EACH ACCIDENT $ ANVPROPRIETOR/PARTNERIEXECUIIVE OFFICERIMEMBEREXCLUDED? NIA E.L. DISEASE - FA EMPLOYE $ (Mandatary in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ A Healthcare Processional Liability Claims Made HN033337 3M5/2021 3/15/2022 Par Event Limit Aggregate Limit Rather Data 1,000,000 3.000,000 03/31/2014 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may, be attached if more space is required) General Liability with Automobile Liability blanket additional insured applies when required by written contract but in no way will the additional insured status exceed the limits, terms or conditions of the policy. General Liability Primary and Non -Contributory coverage applies when required by written contract. General Liability and Automobile Liability blanket waiver of subrogation applies when required by written contract but in no way will the additional insured status exceed the limits, terms or conditions of the policy. Excess Liability policy follows form of underlying policy schedule. Underlying schedule includes General Liability, Hired and Non -Owned Auto and Professional Liability. Additional Insured includes City of Santa Ana its officers, officials, employees, and volunteers as respects General Liability arising out of work or operations See Attached... City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana CA 92702 ACORD 25 (2016103) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Vf.__D,W4J ©1988-2015 ACORD C The ACORD name and logo are registered marks of ACORD Risk Marugement Divisian RENEWED & APPROVED BY: Fa4Mti.1.! Imo. V:11.L4.�¢ ® Rlsk Managentenl Analyst