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DATE(MM/DD/YYYY)
<br /> A�" CERTIFICATE OF LIABILITY INSURANCE 5/27/2026
<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 CONTACT
<br /> NAME:
<br /> Marsh &McLennan (CLW) PHONE FAX
<br /> 101 N Starcrest Dr A/C No Ext: 727 447-6481 vc,Noy 727-449-1267
<br /> E-MClearwater FL 33765 ADDRESS: cicerts@marshmma.com
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURERA: National Fire&Marine Insurance 20079
<br /> INSURED INDUSSUPP01 INSURERB: Hartford Fire Insurance Co. 19682
<br /> Industrial Medical Support Inc
<br /> 5639 Hansel Avenue INSURERC:
<br /> Edgewood FL 32809 INSURERD:
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:1998527338 REVISION NUMBER:
<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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD POLICY NUMBER MM/DD MM/DD
<br /> A X COMMERCIAL GENERAL LIABILITY Y Y HN033337 3/15/2026 3/15/2027 EACH OCCURRENCE $1,000,000
<br /> CLAIMS-MADE OCCUR PREMISES DAMAGE TO
<br /> PREMISES Ea occurrence)
<br /> ccurrence $50,000
<br /> X 5,000 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 JECT PRO � LOC PRODUCTS-COMP/OP AGG $3,000,000
<br /> OTHER: Policy Aggregate $6,000,000
<br /> A AUTOMOBILE LIABILITY Y Y HN033337 3/15/2026 3/15/2027 COMBINED SINGLE LIMIT $1,000,000
<br /> Ea accident
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> X HIRED X NON-OWNED FIR ERTYDAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> A UMBRELLALIAB X OCCUR Y Y EN033337 3/15/2026 3/15/2027 EACH OCCURRENCE $5,000,000
<br /> X EXCESS LAB CLAIMS-MADE AGGREGATE $5,000,000
<br /> DED RETENTION$ $
<br /> B WORKERS COMPENSATION Y 21WECBZ4NMH 2/18/2026 2/18/2027 X PER OTH-
<br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000
<br /> OFFICE R/M EMBER EXCLUDED? ❑ N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> A Professional Liability HN033337 3/15/2026 3/15/2027 Per Event 1,000,000
<br /> Aggregate 3,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Policy Aggregate Limit of$6,000,000 applies to General&Professional Liability subject to the terms,conditions and limits as specified in the policy.
<br /> Professional Liability& Excess Professional Liability are written on a claims-made basis subject to the terms,conditions and limits as specified in the policy.
<br /> Certificate Holder is Additional Insured as respects to General Liability, Hired& Non-Owned Auto Liability,and Excess Liability only if required by written
<br /> contract,and subject to the terms,conditions and limits as specified in the policy.
<br /> Waiver of subrogation applies in favor of certificate holder as respects to General Liability, Hired& Non-Owned Auto Liability, Excess Liability and Workers
<br /> Compensation only if required by written contract,and subject to the terms,conditions and limits as specified in the policy.
<br /> General Liability, Hired& Non-Owned Auto Liability,and Excess Liability are written on a primary and non-contributory basis when required by written contract,
<br /> agreement or permit and subject to the provisions and limitations of the policy.
<br /> See Attached... APPROVED
<br /> CERTIFICATE HOLDER CANCELLATION By Tu Tran Nguyen at 3:45 pm,Jun 17,2026
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> City of Santa Ana* ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Attn: Parks, Recreation, and Community Services
<br /> Agengy AUTHORIZED REPRESENTATIVE
<br /> 20 Civic Center Plaza
<br /> Santa Ana CA 92702
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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