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ACOR" CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDIYYYY) 1 lll./ 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 CONTACT NAME: Nora Vazquez Dodge Insurance SeNICOS, Inc. PHONE FAX DBA Arroyo Insurance Services , 310-356-8207 ac Na:310-356-1825 noDRess: norav@arroyoIns.com 3480 Torrance Blvd., Suite 301 INSURERS AFFORDING COVERAGE NAICff Torrance CA90503 INSURERA: StarStone Natonal Insurance Cc 25496 INSURED INDUS-1 INSURER B : Industrial Medical Support, Inc. 3320 E. Airport Way INSURER C: INSURER D: Long Beach CA 90806 INSURER E : INSURER F COVERAGES CERTIFICATE NUMBER: 486897329 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. LTR TYPE OF INSURANCE INSD D POLICYNUMBER MMDI POLICYEFF MMID�IYYXYY LIMITS COMMERCUILGENERALLUU$ILITY OCCUR EACH OCCURRENCE $ DAMAGCLAIMS-MADE ES[ RENTED PREMISES PREMISES RENT nonce 8 MED EXP (Any one person) $ PERSONAL& ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JEIJOT LOC OTHER: GENERAL AGGREGATE $ PRODUCTS-COMPIOPAGG $ $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per Person) $ BODILY INJURY(Peraccident) $ PROPERTY DAMAGE Per accident $ UMBRELLAUAB EXCESS LMB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOWPARTNER/EXECUTIVE F—y OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA T10211176 4N0/2021 4/10/2022 X I PER OTF4 STATUTE ER EL EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 E.L. DISEASE -POLICY LIMIT 1 $1.000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) California Workers' Compensation Waiver of Subrogation applies as required by written contract. City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana CA 92702 ACORD 25 (2016/03) 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 �'7/' J . D/07IVJ ©1988-2015 ACORD C The ACORD name and logo are registered marks of ACORD Rielr MOlcgonmt DKtimi REVIEWED&pAPPROVED BY: ( ram. f'14t WbA"! ® RUk Management Malyst