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0 CERTIFICATE OF LIABILITY INSURANCE <br />DATEIMM/DDYYYY) <br />06/10/2021 <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($), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION 18 WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER Calhoun & Associates <br />CONTACNAME;T Carmen Ponce <br />DBA: Integrity Advisors <br />14771 Plaza Drive, Ste C <br />PHONE Ean. 800.500-9799 ac No, 714.664-0614 <br />E-MAIL carmen ante nt advisors.com <br />ADDRESS: g y' <br />Tustin CA 92780 <br />INSURERS AFFORDING COVERAGE <br />NAIC# <br />INSURERA: EMPLOYERS <br />31283 <br />INSURED William H. Nuesse, M.D. and Mary -Ann Nuesse, D.O., A Medical <br />INSURERS: <br />867 S TUSTIN ST. <br />INSURER C <br />ORANGE CA 92866 <br />INSURER D: <br />INSURER E: <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />ADD L <br />SUBR <br />POLICY NUMBER <br />POLICY EFF <br />MMIDDIYYYY <br />POLICY EXP <br />MMIDOPYYY <br />LIMITS <br />COMMERCIAL GENERAL LIABILITYLi <br />EACH OCCURRENCE <br />$ <br />CLAIMS -MADE OCCUR <br />EaoD <br />PREMISESS Ea occurrence <br />$ <br />MED EXP (Any one person) <br />$ <br />PERSONAL &ADV INJURY <br />$ <br />AGGREGATE LIMIT APPLI ES PER: <br />GENERALAGGREGATE <br />$ <br />GEN'L <br />POLICY PRJECT O- ❑ LOC <br />PRODUCTS-COMP/OP AGG <br />$ <br />$ <br />OTHER: <br />AUTOMOBILELIABILITY <br />COMBINED SINGLE LIMIT <br />Ea ..;dent <br />$ <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY (Per accident) <br />$ <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />UMBRELLALIAB <br />OCCUR <br />Li <br />EACHOCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED <br />RETENTION $ <br />$ <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANYPROPRIETOWPARTNEWEXECUTIVE YIN <br />OFFICEMMEMBER EXCLUDED? yJ <br />(Mandatory In NH) <br />NIA <br />EIG 2675029 02 <br />08/01/2020 <br />08/01/2021 <br />PER I OTH- <br />STATUTE ER <br />E.L EACHACCIDENT <br />$ 1,000,000 <br />E.L. DISEASE - EA EMPLOYEE <br />$ 1,000,000 <br />If yes, deacrus under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$ 1,OOQ000 <br />I� <br />E:] <br />I--] <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />City of Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza, 4th floor <br />Santa Ana, CA 92701 <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 />©1988.2015 ACORD CI <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />auto RiekManagtmlentDlvleloR <br />/R'EviEwED &rI� ?PRc/v�mBYp: <br />. FdiC4v.�.i.Q R. V+.CtN/taA4 <br />' Risk Management Analyst <br />