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F: <br /> {E <br /> -> DATE(f,:►MIOD(YYYY1 <br /> •- CERTIFI+CATE OF LIABILITY INSURANCE Q�M1/DD/ <br /> THIS CERTIFICATE15ISSUEPASAMATTEROFINFORMATIONONLYANDCONFERSNORIGHTSUPONTHECERTINCATEHOLDER.THIScrRrIFICATEDOESN T'AFFIRMATIVELYORNEGATIVELY <br /> AMEND,EXTEND OR ALTER THE CUVERAGC AFFORDCO BY l'HE POLICIES BELOW.'THIS COITIFICATEOF INSURANCE DOES NOT CONSI ITUTE ACONTRACT BETWEEN THE ISSUING INSURER(S), <br /> AUtJ10RIZPr)REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER- ; <br /> :..'---- ---- _------------- ...... <br /> IMPORTANT:ifthecartilh:alaholdurlsna ADDITIONAL INSURED.The poBcy(ies)muse hove ADDITIONAL INSURED proVlslom.orheendomed.IrSUBROGsA710MISWAiVEta,suhJe"to the ter isand <br /> 1 conditions of the policy,cartainPoliciesInayrequireanendorttroent.AoatementonthisrartlBcatadoaanotcoafcrrightstoJim:re ifrciiteholder Vol Ilea afsuelrendorseawnl(s): 1 <br /> {PRODUCER CONTACT .----�-- ----.-_..___ <br /> NAME: Theresa StmCs <br /> Theresa 8inTes(9744876) <br /> A—a PHONE <br /> -R E —tlsf t . .r_A._x <br /> 17165 Nowhopo$t Ste F (A/C,NOExr):794.9R6.3Q00 � -_-96_6--_3,0..1_3------------ <br /> ):7 <br /> 14 <br /> Fountain Valley CA 92708-4230 _ . <br /> i.;. �..,.. ._.---._.- -...___....__ _.__................. INSURER(S)AFFORDING COVERAGE NAICIJ � <br /> INSURE❑ INSURERA: Tnick insurance)Exchonge 21709 1 <br /> i <br /> iNSURER6: farmers insurance Exchange 21662 <br /> William F1 Nuesse M,D.and Mary Anne Nuesse D,U � <br /> A Medical Cprppratson, INSURERC7 Mid CarTlury lnSUraISCe CDmpany 21687 <br /> INSURERD <br /> dba:Sunrise MultIspeciallst Medical Center ------- <br /> 8G7 8 TUSTIN 5T.ORANGE CA 920M INSURERE: <br /> INsURER F: _ <br /> COVERAGES CERTIFICATE N UM RER: REVISION NUM5211L <br /> I III#141Sr0CFlIt"MYTt-IATIHEPOLICIiSOk04SURANCLUSFL-0BE LOW IIAVE6CEPIISSIAL210tt1LINSURLUNAML ABOVE fORTiq:POLIC:YPERIi0iNUiCATEUNOIWITIJSTANDINGANY --- - <br /> 1ReO1 41--A4f-NT-IrRMORCONIATIL'iNOFANYCONTRACIOROTHERf]OCIJMFNTWIT11rifSPEf-ITOWHICHLI WWERTWICATr MAY BE!SSIRA)OR MAY PERT+liN,TtIrIFf51tRANCEs}FFCtBhE�U(aYTtlt 1 <br /> i'(It ICIESUtSCITIBEUHErRE:INls9URJECT'toALLIHETEQMIS ,EXCLUSIONSANOCIlNDl DW,0FSUCtrPOLIC'IES.LIMIIy514OWNMAYtrAVEBEENRT:UUCEDBYPAIDCLAIMS_ 1 <br /> - _ - <br /> lNSR AODT4 SUrTR �'` POLICY ErF_ POI.iCY E3tP t T'IPEOFINSURAr4CE �--- PDIICYNLIMBi:R —.---`_..._.._�-_.._ ErMITS - <br /> LTR { iNSO WVD (NIM/00/yVYY) (MfsrT/oolyYYY) <br /> COMMERCIAL GENERAL EACHOCCLIRRENCf S --- <br /> I ; _ z,I�nu t3114]: <br /> aecura DAMncE rasrMlEO <br /> j`t:InlriS-+Y1ADF DAMASESST:aCtcaurrr•n;e) <br /> MEDEXP(Anyonaplroiu a 100001 <br /> — - <br /> A I Y Y 602378276 05129/2025 +76129f202d nER5C)rJALaADVINJsIRv t 2,000;004; <br /> W <br /> } l GCN l AGGREGATE LIMIT APPt1ESi PER: GENCRAL AGGREGATE <br /> r l I f PROOUCTS-COMP/OPAGG ) 2,00f1,40ty i PtJUCY PRt>IC.r7 t�_Ir I <br /> t... -OTKV <br /> 9 <br /> I 1 AUTOMOaILELIABILITY �.--_ COMBINEOSINGIELfMFT <br /> i_..F I Eu acduenrJ 2,C100.004, <br /> i I I AF3`1UT0 I OuDILY iN t1J,Y U Plr'un)�b......... <br /> f s .._.._ . <br /> 1 <br /> I I ownErjAUTUS SCHEDULED { <br /> A BODILY INIURY(Pt,arcideolI S f)NLY AUTOS N 02376276 0612912025 05512912026 <br /> I rTrKOAUrns NcrrttTWNEtr ARLJP01Y DAMAGE <br /> x f Q"tY AUTOSONLY Mel accldent) <br /> v ; <br /> I„3 1 t <br /> t i UMBRELLALIAR OCCUR C•ALFIr;TCGUFtREirCL 5. <br /> _ <br /> 01"SS LIAO CLAIMS MADC AGGREGATE b <br /> t <br /> 3 nEn FF REIrNTTOtv2 I __ ....... t <br /> _1_ <br /> WORKERSCOMPENSATEOI4 ' PER 7 }O.fIIriR <br /> AND EMPLOYERS'LIARILITY i STATUTE i b <br /> r - ANYPhrJPrd"0t/PAW'NCR/ V/i; E,l. EACr1ACCIDENI b <br /> MCUTIVE 0r"F#CErVMtMRER N/A <br /> EXCI.UOED'(Ma(ldatOrylnNH) I.DISEASE fACMPLOVC[ <br /> t It ye,.ur-scr4r Under DESCRIPTION(lE <br /> -S ! C)Pc RATIONS tict)w l f L.DISI'ASr.-Pt3tiCY[Wit 3 <br /> DESCRIPTION OF OPFRATIONS/LOCATIONS/VCNLCLES(At`ORD 101.Arlditional Remai ksSthedule,may bo attachod if mare sj)ace is ris ILOred) <br /> 667 S TU5TIN ST,ORANGE,CA 9286C <br /> tattliffeate of Insurance shall provide 30days prior written notloe. Tu TTaTI DI9K.U"lgnedby <br /> Tu Iran Nguyen PPR®li/�`/'► <br /> r l pate 2025.as3o APPROVED <br /> 9I'LL:/ I <br /> r N U E'I'1,4 te:ss erne-_- -,- By To Trap Nguyen at 2:17 pm,May 8U,2025 <br /> y <br /> CERTIFICAT P HOLDER CANCELLATION <br /> SHOULOANYOFTHEABOVE DESCRIBED POLICIES SE CANCELLED BEFORE THE ExP)RATION <br /> RISK MANAGEMENT DIVISIORI DATETwEREOF NOTICE WILL BE DELIVERED IN ACCORDANCE WITH lilf POLICY PROVISIONS <br /> : <br /> 20 CIVIC CENTER PLZ AurwctRlx�r�RfJ=RESENTATtvE ��� _— <br /> SANTA ANA CA 92701 <br /> ACORD 25(2016/03) =E)19$8-20 I S ACORD CORPORATION.All Rights Reserved <br /> 0.1769 11.15 The ACO RD narne and logo are registered InarkS of ACORD <br />