WILLIAM H. NUESSE M.D. AND MARY ANN NUESSE, D.O. dba SUNRISE MULTISPECIALIST MEDICAL CENTER (2)

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�" DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 09/30/2025 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 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 Calhoun&Associates CONTACT NAME: Carmen Ponce DBA: Integrity Advisors (PHONE.,Ext:800-500-9799 FAX No:714-664-0614 14771 Plaza Drive,Ste C E-MAIL carmen mte ri advisors.com ADDRESS: g ty" Tustin CA 92780 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:REPUBLIC INDEMNITY CO OF AMERICA 19739 INSURED William H.Nuesse,M.D.and Mary-Ann Nuesse,D.O. INSURERB: Sunrise Multispecialist Medical Center INSURERC: 867 South Tustin Street INSURER D ORANGE CA 92866 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD MM/DD COMMERCIAL GENERAL LIABILITY L1 EACH OCCURRENCE $ —1 CLAIMS-MADE ❑ OCCUR -PREMISES DAMAGE TO PREMISES Ea occurrence) ccurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ YIEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑ PRO JECT ❑ LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY ❑ COMBINED SINGLE LIMIT $ Ea accident eANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS uHIRED NON-OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY Per accident lul u $ UMBRELLALIAB OCCUR F EACH OCCURRENCE $ u EXCESS LIAB u CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE Li ER A ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N 256017-04 08/01/2025 08/01/2026 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? 1 N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 Digitally signed 00 TU Tr an byTuTran Nguyen Date:2025.10.07 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) ' 45 The Waiver of Subrogation applies to the City of Santa Ana, its City Council,officers,officials,employees,agents,and volunteers. APPROVED By Tu Tran Nguyen at 10:45 am,Oct 07,2025 CERTIFICATE HOLDER CANCELLATION City of Santa Ana Attention: Human Resources Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE p THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 Civic Center Plaza, CA 92701 ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD