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ACC"h® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD YYY) 7/3/2014 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(les) must 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 NAME: NTA T Michelle Goodwin InterWest Insurance .Services 22 CLicense #0601094 222 Court Street PHONE FAX - - AIC No : - - EMAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC 9 Woodland CA 95695 INSURER ASCOttSdale Insurance Co. IJ297 DAMAGE _TRENT PREMISES Ea occurrence $1,000,000 INSURED USHEA-1 INSURER B:Safety National INSURER C:ZUr Ch North America U.S. Healthworks Holding Company, Inc. 25124 Springfield Ct., Ste 200 Valencia CA 91355 INSURER D: PRODUCTS-COMP/OP AGO $2,000,000 $ INSURER E: INSURER F: LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X AUTOSOWNED COVERAGES CERTIFICATE NUMBER: 969175296 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 LTR TYPE OF INSURANCEADDLSUSR SR MD POLICYNUMBER POLICY EFF MMIDONYYY) POLICY EXP (MMIDDIYYYY1 LIMITS C GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE IX OCCUR Y CP0647613600 y AN'l}t�ls f�.)� S' /1/2013 FOR" /1/2014 EACH OCCURRENCE $1,000,000 DAMAGE _TRENT PREMISES Ea occurrence $1,000,000 MED EXP IAny oneperson) $10,000 PERSONAL &ADV INJURY $1000000 _ GENERAL AGGREGATE $2000,000 GEN'L AGGREGATE LIMIT APPLIES PER:7(/f PHI- 1-__I LOC 17 POLICY PRODUCTS-COMP/OP AGO $2,000,000 $ C AUTOMOBILE X 'X LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X AUTOSOWNED CP0647613600 - I ASST /1/20.1 V7r �( Y f- 11 /1/2014 Ea accident$1,000.000 BO DILY INJURY (Per person) $ BO DILY INJURY (Per accident) $ Pena scolded DAMAGE $ $ AXUMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE XLS0089886 /1/2013 /1/2014 EACH OCCURRENCE $15,000,000 AGGREGATE $15,000,000 DED RETENTION$ I $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YINLIM PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICEMEMBER EXCLUDED? W (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA LDC4042721 /1/2013 /1/2014 X WC 8TATU- `ETR_ CRYANY EL EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE -POLICY LIMIT $1.000.000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD t Di, Additional Remarks Schedule, if more space is required) Certificate holder is included as additional insured as required by written contract per the attached endorsement Re: 1619 East Edinger, Santa Ana, CA 92705 CERTIFICATE HOLDER CANCELLATION ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza Santa Ana CA 92701 AUTHORIZED REPRESENTATIVE ,l'V Lt,�',Glntt. �L(b.�wuU r ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD