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

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ACOR" DATE MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE7051/28/2025 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 i 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: Theresa Simes Theresa Simes(9744876) PHONE FAX 17165 Newhope St Ste F (A/C.NO,EXT): 714-966-3000 (A/C.NO):714-966-3013 E-MAIL - Fountain Valley CA 92708-4230 aooREss: tsimesQ(armersagent.com i INSURER(S)AFFORDING COVERAGE NAIC x INSURED INSURERA: Truck Insurance Exchange 21709 William H Nuesse M.D. and Mary Anne Nuesse D.O INSURER B: Fanners Insurance Exchange 21652 A Medical Corporation. INSURERC. Mid Century Insurance Company 21687 INSURER D: dba:Sunrise Multispecialist Medical Center 867 S TUSTIN ST.ORANGE CA 92866 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: ['HIS 15 TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OROTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDTL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DD/YYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 2,OW,00 CIAIMSMADF OCCUR DAMAGETORENTED S PREMISES(Ea Occurrence) 1,000.00 MED EXP(Any one person) S 10.000 A Y Y 602378275 05/29/2025 1 05/29/2026 PERSONAL&ADV INJURY $ 2.000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 400000 X POLICY ❑ PROJECT ❑ IOC PRODUCTS-COMP/OPAGG S 2,000,00 OTHER' $ A COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY $ (Ea accident) 2,000.000 ANY AUTO BODILY INJURY(Pet person) S A OWNED AUTOS SCHEDULED ONLY AUTOS N 602378275 05/29/2025 05/29/2026 BODILY INJURY(Per accident)$ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ ONLY AUTOSONLY (Per accident) UMBRELLA LIAS OCCUR EACHOCCURRENCE $ EXCESS LIAS CLAIMS MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTHER $ AND EMPLOYERS'LIABILITY STATUTE ANY PROPRIETOR/PARTNER/ Y/N E.L.EACH ACCIDENT $ EXECUTIVE OFFICER/MEMBER N/A EXCLUDED?(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 67 S TUSTIN ST,ORANGE,CA 92866 ertiificate of insurance shall provide 30days prior written notice. TU Tfd Il DlgltAly signed by D,i er 2025.0530 APPROVED Ng Uyen 14:18s5-07'00' By Tu Tran Nguyen at 2:17 pm,May 30, 2025 CERTIFICATE HOLDER CANCELLATION CITY OF SANTA ANA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION RISK MANAGEMENT DIVISION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 CIVIC CENTER PLZ AUTHORIZED REPRESENTATIVE SANTA ANA CA 92701 ACORD 25(2016/03) !t)1988-2015 ACORD CORPORATION.All Rights Reserved 31-1769 11-15 The ACORD name and logo are registered marks of ACORD