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AC"R"' CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MM/DD/YYYY) <br />11111 2/16/2018 <br />1 2/9/2018 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER Lockton Companies <br />8110 E. Union Avenue <br />Suite 700 <br />Denver CO 80237 <br />NAME; T <br />PH NE FAX <br />A/C No Ext : A/C No): <br />E-MAIL <br />ADDRESS: <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />(303) 414-6000 <br />INSURER A : Arch Specialty Insurance Company <br />21 199 <br />INSURED WellDyneRX, LLC. <br />1424829 500 Eagles Landing Drive <br />Lakeland, FL 33810 <br />INSURER B : Zurich American Insurance Company <br />16535 <br />INSURER C : Lexington Insurance Company <br />19437 <br />INSURER D : Ll0 CIS Of London <br />INSURER E: Berkley Insurance Company <br />32603 <br />t " <br />t <br />INSURER F <br />COVERAGES CERTIFICATE NUMBER: 14516082 REVISION NLIMRER- XXXXXXX <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />ADDL. <br />INSD <br />SUBR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MM/DD/YYYY <br />POLICY EXP <br />MM/DD/YYYY <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />N <br />N <br />FLP006017701 <br />2/16/2019 <br />2/16/2019 <br />EACH OCCURRENCE <br />5 1,000,000 <br />CLAIMS -MADE OCCUR <br />]{ <br />DAMAGE TO RENTED <br />PREMISES Ea occurrence <br />100,000 <br />IVIED EXP (Any oneperson) <br />5,000 <br />PERSONAL & ADV INJURY <br />$ 1 000 000 <br />GEN'L AGGREGATE LIMIT APPLIES PER. <br />POLICY❑ JECT ❑ LOC <br />GENERAL AGGREGATE <br />$ 3,000,000 <br />PRODUCTS -COMP/OP AGG <br />$ 3,000,000 <br />$ <br />OTHER: <br />• <br />AUTOMOBILE <br />LIABILITY <br />N <br />N <br />FLP006017701 <br />2/16/2018 <br />2/16/2019 <br />COeBINEDtSINGLE LIMIT <br />$ 1,000,000 <br />BODILY INJURY (Per person) <br />$ xxxxxxx <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY (Per accident <br />$ XXXXXXX <br />AUTOS ONLY x AUUTOS ONLYY <br />x <br />Peo, :c d nDAMAGE <br />$ XXXXXXX <br />$ xxxxxxx <br />A <br />]{ <br />UMBRELLA LAB <br />X 'OCCUR <br />N <br />N <br />FLP006017701 <br />2/16/2018 <br />2/16/2019 <br />EACH OCCURRENCE <br />$ 10,000,000 <br />AGGREGATE <br />$ 10,000,000 <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED I I RETENTION $ <br />$ xxxxxxx <br />B <br />WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N <br />N <br />WC014390901 <br />2/16/2018 <br />2/7/2019 <br />X STATUTE o R <br />E.L. EACH ACCIDENT <br />$ I OOO OOO <br />ANYOFFICER MEMBOER EXCLUDED? ECUTIVE FN <br />(Mandatory in NH) <br />It yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />N / A <br />E.L. DISEASE - EA EMPLOYEE <br />_JjJ]000,000 <br />E.L. DISEASE - POLICY LIMIT <br />1, 1,000,000 <br />A <br />C <br />Phannacvprof ljab <br />PBM E&O Liab. <br />N <br />N <br />FLP006017701 <br />012110742 <br />2/16/2018 <br />2/16/2018 <br />2/16/2019 <br />2/16/2019 <br />$IM/$3M <br />Limit: $8M/Ret $250K <br />D <br />E <br />Cyber <br />Crime <br />MPL184736417 <br />BCCR4500242320 <br />2/16/2017 <br />10/21 /2016 <br />2/16/2018 <br />2/16/2018 <br />Limit: $5M Ea. Claim/$5M Agg <br />Limit: $2M per Oce. <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />CERTIFICATE HOLDER CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />14516082 AUTHORIZED REPRESENTATIVE <br />City of Santa Ana <br />ATTN: Christy Kindig <br />20 Civic Center Plaza, M-21 <br />Santa Ana, CA 92701 <br />9 <br />C % <br />&rili ram( <br />ACORD 25 (2016/03) ©1988 2015 ACORD CORPOWATION. All rights reserved <br />a0 <br />The ACORD name and logo are registered marks of ACORD <br />