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AC" OR ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) <br /> llh � 3/15/2026 3/20/2025 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. <br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER Lockton Companies,LLC CONTACT <br /> DBA Lockton Insurance Brokers,LLC in CA PHONE FAX <br /> A/C No t• AIC,No): <br /> CA license#OF15767 E-MAIL <br /> 1185 Avenue of the Americas,Ste.2010 ADDRESS__ <br /> New York NY 10036 INSURER(S)AFFORDING COVERAGE NAIC# <br /> (646)572-7300 _ _ INSURER A:National Fire and Marine Insurance Co 20079 <br /> INSURED Industrial Medical Support,Inc. _ <br /> INSURER B <br /> 1527640 5639 Hansel Ave INSURER C: <br /> Edgewood, FL 32809 INSURER D: <br /> INSURER E <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 20395522 REVISION NUMBER: XX}Q{XXx <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR ADDL SUBR POLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDIYYYY MMIDD/YYYY LIMITS <br /> A <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1000 000 <br /> Y Y HN033337 3/15/2025 3/15/2026 DAMAGE-TO-RENTED <br /> CLAIMS-MADE a OCCUR PREMISES Ea occurrence $ 50,000 <br /> MED EXP(Any one person) $ 5,000 <br /> _ PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000 000 <br /> POLICY❑JECOT- L X 1 LOG <br /> PRODUCTS-COMPlOPAGG $ 3,000,000 <br /> OTHER: S <br /> AUTOMOBILE LIABILITY NOT APPLICABLE COMBINED SINGLE LIMIT $ <br /> Ea accident XXXXXXX <br /> ANY AUTO BODILY INJURY(Per person) $ XXXXXXX <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS XXXXXXX <br /> HIRED AUTOS ONLY AUTOS ONLDY Pe a c den DAMAGE $ XXXXXXX <br /> sXXXXXXX <br /> A UMBRELLA LIAB OCCUR N N EN033337 1/15/2021 3/11/2026 EACH OCCURRENCE 5 5,000,000 <br /> X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 <br /> 7— DECT RETENT Is XXX'XXxx <br /> WORKERS COMPENSATION NOT APPLICABLE <br /> AND EMPLOYERS'LIABILITY PER OTH- <br /> YIN ( STATUTE I ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ xxxxxxx <br /> OFFICERIMEMBER EXCLUDED? NIA XXXXXXX <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ XXXXXXX <br /> A Healthcare Professional N N HN033337 3/Li/2025 3/15/2026 Per Event:S1,000,000 <br /> Liability Aggregate:$3,000,000 <br /> I. Retro Date:3/31/2014 <br /> I <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> THIS CERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR THIS BOLDER.APPLICABLE TO THE CARRIERS LISTED AND THE POLICY TER.NI(S)REFERENCED. <br /> City of Santa Ana,its City Council,officers,officials,employees,agents,and volunteers are included as Additional Insured on the General Liability as required by written <br /> contract.A waiver of subrogation applies per written contract. <br /> Tu Tran Digitally signed 6y <br /> Tu Tfan Nguyen APPROVED <br /> Dare:2025.04.23 <br /> Nguyen DZ48:47.DTOD' <br /> 8y Tu Tran Nguyen at 7:47 am,Apr 23, 2025 <br /> CERTIFICATE HOLDER CANCELLATION See Attachment <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> 20395522 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Attn: Parks, Recreation,and AUTHORIZED REPRF.:;,.IA11VE (" <br /> Community Services Agency <br /> 20 Civic Center Plaza <br /> Santa Ana,CA 92702 <br /> �t <br /> ©1988.2015 ACORD COI RPORATION. 7A I rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />