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ACORDrM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDlYYYY) PRODUCER 5/1/2010 4/28/2009 LOCKTON COMPANIES, LLC THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 5847 SAN FELIPE, SUITE 320 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOUSTON TX 77057 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 866-260-3538 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURED U.S. HEALTHWORKS, INC. 1306185 25124 SPRINGFIELD COURT, SUITE 200 VALENCIA CA 91355 COVERAGES NL INSURERS AFFORDING COVERAGE NAIC # WSURER A : Hartford Casualty Insurance Company 29424 INSURER a : The Doctors Co, An [nterlns Exchange 34495 WSURER c: Liberty Mutual Fire Insurance Company 2303 INSURER D: INSURER E Irv~urttK 5 AUTHORIZED REPRESENTATIVE OR~PRODUCER AND THE CERTIFICATE HOLD INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR ADD'L LTR INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE (MM/DD/YYl DATE (MMIDD/YY) LIMITS GENERAL LIABILITY A X COMMERCIAL GENERAL LIABILITY 61 UENHY9296 EACH OCCURRENCE $ ] 000 ~~~ 9/1/2009 9/1/2010 DAMAGE TO RENTED CLAIMS MADE ~ OCCUR PREMISES Ea occurence $ 300 000 MED EXP (Any one person) $ ] Q 000 PERSONAL & ADV INJURY $ 1 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3 000 000 PRO- POLICY JECT X LOC PRODUCTS - COMPJOP AGG $ 3 OQ~ 000 C AuromoBlLE LIABILITY AS2-691-450294-029 9/1/2009 9/1/2010 X ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per person) XXXXXXX X HIRED AUTOS X NON-OWNED AUTOS y "I-{ r ~~`1,~~, (PerOacci ent)RY $ 9 XXXXXXX ~ y ~ y'`~~ 1~, c-~ ~ PROPERTY DAMAGE $ l e.. ~~ accident) XXXXXXX GARAGE LIABILITY NOT APPLICABLE ANY AUTO 4-~t~J AUTO ONLY - EA ACCIDENT $ - XXXXXXX ` ' Rlt ~r~,~ N EA ACC $ ~ c1 urd ti ,~ O XXXXXXX EXCESSIUMBRELLA LIABILITY g ~~+" ' UTOONLY 1LV AGG $ l~SSt XXXXXXX OCCUR ~ CLAIMS MADE EACH OCCURRENCE $ }~}~X'X'XXX NOT APPLICABLE UMBRELLA AGGREGATE $ XXXXXXX DEDUCTIBLE FORM $ X}~}{X'X'~(X RETENTION $ $ XXXXXXX C WORKERS COMPENSATION AND WA2-69D-450294-019 EMPLOYERS' LIABILITY 9/]/2009 $ 9/1/2010 X O XXXXXXX ANY PROPRIETORlPARTNER/EXECUTIVE ORY IMITS ER OFFICER/MEMBER EXCLUDED? E. L. EACH ACCIDENT $ 1,000,000 If yes, describe under SPECIAL PROVISIONS below NO E.L. DISEASE - EA EMPLOYEE $ 1,000,000 B OTHER 0069727 E.L. DISEASE -POLICY LIMIT $ 1,000,000 Medical Professional Liability: Claims Mad 5/1/2009 $/1/2010 $1,000,000 Per Claim e $3,000,000 Annual Aggregate Deductible: $1OQ000 Per Claim DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS NOTE: MEDICAL PROFESSIONAL LIABILITY GROUP RETROACTIVE DATE 10/1/95. ADDITIONAL INSURED IN FAVOR OF CITY OF SANTA (ON ALL POLICIES EXCEPT WORKERS' COMPENSATION/EL AND THE MEDICAL PROFESSIONAL LIABILIT REQUIRED BY WRITTEN CONTRACT ANA . Y) WHERE AND TO THE EXTEN T CERTIFICATE HOLDER 10477112 CANCELLATION CITY OF SANTA ANA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 20 CIVIC CENTER PLAZA DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3O DAYS WRITTEN SANTA ANA CA 92701 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIV ~!~ ACORD 25 (2001/08 For ea 9 ] questions re bin this certfficate, contact the number listed in the 'Producer section ab ove. © AC D CORPO RATION 1988