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ACCMbir CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 1 li 03/05/2020 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 have ADDITIONAL INSURED provisions or 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 CONC NAME:TACarmen Ponce Calhoun &Associates PHONE IAI,No. E�u,g00-500-9799 aC N774.664-0614 DBA: Integrity Advisors n ORess: carmen@integrity-advisors.com 14771 Plaza Drive, Ste C INSURERS AFFORDING COVERAGE NAIC# Tustin CA 92780 INSURER,: EMPLOYERS 31283 INSURED William H. Nu/esse, M.D. and Mary -Ann Nuesse, D.O., A INSURER B : Medical ✓ INSURER C: 867 S TUSTIN ST. WsuRER D INSURER E ORANGE CA 92866 INSURER F COVERAGES CERTIFICATE NUMBER: RFVISInN NUMRFR- 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 INSURANCE ADDLSUSR POLICY NUMBER POLICY EFF MMIODIYYYY POLICY UP (MMODlYYY"I LIMBS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ DAMAGETO-RENTED PREMISES Ea occurrence $ N ED UP (Any one person) $ PERSONAL &AOV INJURY $ GENT AGGREGATE LIMIT APPLIES PER: POLICY JET LOG GENERALAGGREGATE $ PRODUCTS -COMPIOP AGG $ $ OTHER: AUTOMOBILE LIABILITYLi COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS accident Per 8001LV INJURY ( ) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accima t $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS-MADE DED RETENTIONS Z $ A WORKERS COMPENSATION or AND EMPLOYERS' LIABILITY ANYPROPRIETORIPARTNEWEXECUTIVE YIN (Mandatory inN REXCWDEDP Y❑ Ifyes,dgryin NH) NIA EIG267502901 08/01I2019 ✓ 08I01I2020 ✓ PER OTH- STATUTE ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $ 1rDDOrODO DEescribe under SCRIPTION OF OPERATIONS be. E.L. DISEASE -POLICY LIMIT $ 1,000,000 00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) REVIEWED & APPROVED By Risk MANAGEMENT DIViSiON 8Uw 020 CERTIFICATE HOLDER CANCELLATION City of Santa Ana ✓ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Risk Management Division 20 Civic Center Plaza, 4th floor THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana, CA 92701 AUTHORIZEDREPRESENTATIVE 4 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD