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I T ACOR CERTIFICATE OF LIABILITY INSURANCE DATE IMMIDDA'YYY) 4/28/2016 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 InterWest Insurance Services License #0801094 222 Court Street CA FACT Michelle Goodwin, CIC, CISR, CPSR PHONE . 831- 635 -2247 FAX 6831- 636 -6801 . mgoodwin @iwins.com R:,ggoodwin@iwins.com INSURERS AFFORDING COVERAGE NAICq Woodland CA 95695 INSURERA:NORCAL Mutual Ins Company 33200 INSURED USHEA -1 INSURER B: $ INSURER C: CLAIMS -MADE 0 OCCUR U.S. Healthworks, Inc. 25124 Springfield Ct., Ste 200 Valencia CA 91355 INSURER 0 INSURER E: $ INSURER F: MED EXP lAny one person) $ COVERAGES CERTIFICATE NUMBER: 880317952 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 R TYPE OF INSURANCE Santa Ana CA 92701 POLICY NUMBER POLICY D EYY MMLDOY EYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE 0 OCCUR DAMAGE TO RENTED PREMISES IE c $ MED EXP lAny one person) $ PERSONAL &ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY ❑ PRO- ECT ❑ LOG PRODUCTS - COMP /OP ASS $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LI Ea accident $ BODILY INJURY (Per person) $ ANY AUTO ALL AUTOS OWNED AUTOSULED BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DUD RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN I PER OTH- STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER /MEMBER EXCLUDED? ❑NIA E.L. DISEASE -EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DE SCRIPTION OF OPERATIONS below E. L. DISEASE - POLICY LIMIT $ A A Medical Malpractice Professional Liability 721820E 721823N 5/1/2016 5/1/2016 5/1/2017 5/112017 Aggregate $3,000,000 Limit $1,000,000 $150,000 Ded IL /CAFrX/FL /WA Ded. -All Other Slates $100,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Add ltlonal Remarks Schedule, may be attached If more space Is required) Although multiple policies are shown above, the person or organization identified above as the Insured qualifies as an Insured under only one of those policies shown, and the coverages and limits of liability for such coverages of only one of those policies will apply to that Insured. Re: 1619 East Edinger, Santa Ana, CA 92705 CERTIFICATE HOLDER CANCELLATION 10 Days for Non Payment of Premium ACORD 25 (2014/01) @ 1988.2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 Civic Center Plaza ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana CA 92701 AUTHORIZED REPRESENTATIVE ACORD 25 (2014/01) @ 1988.2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD