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I T ® CERTIFICATE OF LIABILITY' INSURANCE DATE (MM /DDIYYYV) s)DATE(Ms 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 endorsement(s). PRODUCER InterWest Insurance Services License #01301094 222 Court Street CONTACT Michelle Goodwin CIC CISR CPSR PHONE ,g31- 635 -2247 FAX .831- 638 -6801 P.0 EMAIL . mgoodwin @iwins.com INSURER (S) AFFORDING COVERAGE NAIC q Woodland CA 95695 INSURER A: Liberty Mutual Fire Ins Co 23035 $_1,00_0L. 000 INSURED USHEA -1 INSURER B:Liberty Insurance Corporation 42404 INSURER C:Safety National Casualty Corp 15105 U.S. Healthworks Holding Company, Inc. 25124 Springfield Ct., Ste 270 Valencia CA 91355 INSURER D $1,000000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY [:] JPECOT T LOC OTHER: GENERAL AGGREGATE $2000,000 INSURER E: $2,000,000 INSURER F: $ • COVFRAr;FR CERTIFICATE NIIMBF_R- 863365504 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. IL3R TYPE OF INSURANCE INSD WIG POLICY NUMBER MMfDDYEFV MMDDYEYY LIMITS • X COMMERCIAL GENERAL LIABILITY CLA1MS-MADE T OCCUR Y TB2691450294035 9/1/2015 9/1/2016 EACH OCCURRENCE $_1,00_0L. 000 DAMAGE TO RENTED PREMISES Ea occurrencel . $1,000,000 MED EXP Anyone arson $10,000 PERSONAL B ADV INJURY $1,000000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY [:] JPECOT T LOC OTHER: GENERAL AGGREGATE $2000,000 PRODUCTS - COMP /OP AGO $2,000,000 $ • AUTOMOBILE X X IAUTOS LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS X NON -OWNED AS2691450294045 9/1/2015 9/1/2016 EU as tleo1S NGLE LIMIT $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE TH7691450294055 9/1/2015 9/112016 EACH OCCURRENCE $25,000,000 AGGREGATE $25,000,000 DEO X I RETENTION $10,000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA LDC4042721 9/112015 9/1/2016 X STATUTE ER E.L. EACH ACCIDENT $2,000,000 E.L. DISEASE - EA EMPLOYEE $2,000,000 E.L. DISEASE- POLICY LIMIT $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached 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 `10 days notice for nonpayment @ 1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD p- tj�e"xA. cp- �(.Irt�i. Y"1 rwtU�^�.- l �� 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 @ 1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD p- tj�e"xA. cp- �(.Irt�i. Y"1 rwtU�^�.- l ��