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,4coR®®CERTIFICATE OF LIABILITY INSURANCE OATE(MMDOIYYYY) 9/2/2014 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(ies) 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 endorsements). PRODUCER CONTACT NAME: Michelle Goodwin InterWest Insurance Services License #0801094 222 Court Street PHCNNO E.01831-635-2247aC No: 1-6801 EMAILss:m OodWin IWI INSURERS AFFORDING COVERAGE NAIC H Woodland CA 95695 INSURERA-.Zurich-Amer can Insurance Go 16535 DAMAGE TO ft TED PREMISES Eacccurre ca $1,000,000 INSURED USHEA-1 INSURER B : O 41297 INSURERC:Safet Ngligoal Casualty Corp5105 U.S. Healthworks Holding Company, Inc. 25124 Springfield Ct., Ste 200 Valencia CA 91355 N-2014-093-001 NSURER D: PRODUCTS - COMP/OP AGO $2,000,000 § INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 1842282239 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 rypE OF INSURANCE D IN R S R WD POLICY NUMBER POLICY EFF MM/DDNYYY POLICY EXP MMIDONVYV LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR Y CP0647613601 /1/2014 /1/2015 EACH OCCURRENCE $1,000,000 DAMAGE TO ft TED PREMISES Eacccurre ca $1,000,000 MED FXP(Any one error) $10,000 PERSONAL &ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE POLICY LIMIT APPLIES PER: PRO- JOCT X LOC PRODUCTS - COMP/OP AGO $2,000,000 § A AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED X HIRED AUTOS X AUTOS CP0647613601 /1/2014 /1/2015 Ea accident $1,000000 BODI LV I NJ URV(Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ B UM13RELLALIAB X EXCESS LIAR X OCCUR CLAIMS -MADE XLS0094380 /1/2014 /1/2015 EACH OCCURRENCE $15,000,000 AGGREGATE $15,000,000 DED RETENTION$ $ C WORKERS COMPENSATION AND EMPLOYERS LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA LDC4042721 /1/2014 /1/2015 X TWC STATU- OT H. E.L. EACH ACCIDENT $2,000,000 E.L. DISEASE -EA EMPLOYE $2,000,000 E.L. DISEASE - POLICY LIMIT $2 W. 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,AddlUonal Remarks Schedule, if more space is required) Certificate holder is included as additional insured as required by written contract per the attached end ement r®Kjjyj Re: 1619 East Edinger, Santa Ana, CA 92705 AYly, jVED "p"® Joseph 9t a —t rity ttorney City of Santa Ana 20 Civic Center Plaza Santa Ana CA 92701 ACORD 25 (2010105) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED ©1988.2010 ACORD CORPORATION. All riOhtst The ACORD name and logo are registered marks of ACORD