WILLIAM H. NUESSE M.D. AND MARY ANN NUESSE, D.O. dba SUNRISE MULTISPECIALIST MEDICAL CENTER

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___� ACC>R "a CERTIFICATE OF 10117120 LIABILITY INSURANCE DATE /YYYY) 17l2024 THIS CERTI FICATE IS ISSUED AS A MATTER OFINFORMATION ONLY AND CONFERS O RIGHTS UPON THE CERUFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGA"fIVEI.Y AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. TI IIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), j AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. FIMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) mu oa have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the Policy, certain policies may requi re an endorsement. A statement n this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Theresa Simes Theresa Simes(9744876) 17165 Newhope St Ste F Fount a! vg i-e 927 42 AN 1. ..eve INSURED William H Nuesse M.D. and Mary Anne Nuesse D.O. A Medical Corporation DBA: Sunrise Multispecialist Medical Center 8637 S. TUSTIN ST. ORANGE CA 92866 COVERAGES CERTIFICATE NUMBER: Ti iIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN IS_ REOUIREMENT. TERM OR CONDITION OF ANY CONTRACTOR OTHFR DOCUMENT WI1 POUCIES DESCRIBED i rERLIN IS SUBJECT 1-0 ALL i HE I+RMS. EXCLUSIONS AND CON . INSR ADDTL SUOR Ll R TYPE OF INSURANCE INSD WVD COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR A Y N 602378 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY n PROJECT n LOC �J LJ OTHER - AUTOMOBILE LIABILITY ANY AUTO F A I OWNEDALITOS I SCHEDULED I r I ONLY I AUTOS N ,602378 HIREDAUTOS �X NON -OWNED ON LY AUTOS ONLY UMBRELLA LIAR OCCUR B EXCESS LIAB CIAIMS-I AADE I fED RUI t=N I ION S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PAR'I NER/ WN EXECUi IVE OFFICER/MEMBER EXCLUDED? Wandatory in NH) If ties, describe under DESCRIPTION OF OPERATIONS below N/A PHONE FAX (A/C, NO, EXT): 714-966-3000 (A/C, NO): 714-966-3013 E ILL A : i to rnedab Anaie Ac_ev_ec� ftsr INSURERS AFFORDING COVERAGE 'AIC P I e u JeQxclatgelT 6:07:55 -07I 00709 INSURER B: Farmers Insurance Exchange 21652 INSURERC: Mid Century Insurance Company 21687 INSURER D: INSURER E: INSURER F: REVISION NUMBER: UEDTOTHE INSURED NAME ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY H RESPECT TO WHICH THISCERTIFICATE MAY BE ISSUED OR MAY PERTAir4. THE INSURANCEAFFORDED BY THE -ITIONS OF SUCH POLICIES. LIMBS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. -OLICY NUMBER POLICY EFF POLICY EXP T LIMITS (MM/DD/YYYY) I (MM/DD/YYYY) 5 ?75 71781I}81 I DESCRIPTION OF OP :RATIONS/LOCATIONS/ VEHICLES (ACORD 101, Additional Rer P67 S TUSTIN ST, ORANGE, CA 92866 jCertificate of insurance shall provide 30days prior written notice of can CERTIFICATE HOLDER CITY OF SANTA ANA 20 CIVIC CENTER PL? SANTA ANA ACORD 25 (2016/03) 31-1769 1 1.15 CA 92701 The ACORD name EACH OCCURRENCE —I$ 2.000.000 DAMAGE TO RENTED f PREMISES (Ea Occvrrence) $ 1,000.000 M E D EX (Arty ory person) 'S 10000 05/29/2025 ! PERSONAL &ADV INIUK'y dS 2.000,000 I GkN£RAL AGGREGATE 4,000,000 PRODUCTS -COMP/OPAGG 'S 2,000.000 g COMBINED SINGLE LIMIT (Ea accident) 2,000,000 BODILY INJURY (Per person) �5 I 05/29/2025 BODILY INJURY (Per accident)'S PROPERTY DAMAGE (Per accident) IS EACH OCCURRENCE h5 1,000.000 - I 05/29/2025 1 AGGREGATE S 1,000.00 3 PER STATUTE OTHER S E.L. rACH ACCIDENT S E L. DISEASE- EA I:MPI.OYEE b E.L. DISEASE - POLICY LIMIT F rks Schedule, may he attached if more space is required) I:ellation CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES I: DATE THEREOF. NOTICE WILL BE DELIVERED IN ACC DMsion AUTHORIZED REPRESENTATIVE EEED PRCFVEDBy . �I �. Risk Management Specialist n 1988-2015 ACORD i nd logo are registered marks of ACORD