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AC4RDF CERTIFICATE ©F LIABILITY INSURANCE DATE IMMfODIYYYYI f 01/08/2026 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 1NSURER(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: JAMES DRl 1FUS PHONE Ent) 562 430-4704 FAX Na): Southeast Counties Insurance E-MAIL ADDRESS: famesdreifus msn.cOm @ 10405 Los Alamitos Blvd INSURERS AFFORDING COVERAGE _ NAIC 0 INSURER A: Hartford Insurance Company 0022323 Los Alamitos CA 90720 INSURED INSURER B _ INSURERC: Forensic Nursing Specialist, Inc. INSURERO: 10413 Las Alamitos Blvd INSURER E : _ Los Alamitos Ca 90720 INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTI_D BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM CR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURrkNCE 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 L TYPE OF INSURANCE ADDL SUBR�rLICY NUMBER POLICY k LDDNYY EXP I AiMIDDJYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000. � CLAIMS -MADE OCCUR l� `�l $ 1,000,D00. AM `�MN PREMISES Ea occurrence MED EXP (Any one person) $ 10,000. PERSONAL &ADV INJURY A X X 57 SBA BG8EGA 01/09/2026 01/0912027 $ 2,000,000. GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000. POLICY � PRO LOC JECT $ 4,000,000. PRODUCTS - COMPIOP AGG OTHER: Is AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY f Per accident) $ v PROPERTY DAMAGE JPer accident 5 HIRED NON -OWNED AUTOS ONLY AUTOS ONLY + UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE EXCESS LIAB CLAIMS -MADE $ $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN 'ANYPROPRIETOR7PARTNER EXECUTIVE PER OTH- STATUTE ER $ E.L. EACH ACCIDENT OFF ICERIMEMBEREXCLUDED? ❑ NIA E.L. DISEASE - EA EMPLOYEE $ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT I S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Nursing office City of Santa Ana 20 Civic Center Plaza, Santa Ana, CA 92701 and elected and appointed boards, officers, officials, agents, employees, and representatives added as an additional insured to the General Liability effective 0' -09-2024 per the policy's terms and conditions APPROVED CERTIFICATE HOLDER CANCELLATION By Tu Tran Nguyen at 9:32 am, Jan 28, 2026 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WrrH THE POLICY PROVISIONS. City of Santa Ana AU RIZED REPAFI E 20 Civic Center Plaza Santa Ana, CA 92701 i �`� ��/y O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD