SUNRISE MULTISPECIALIST MEDICAL CENTER WILLIAM H. NUESSE, M.D. AND MARY ANN NUESSE, D.O.)

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A V CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDD1YYYY) 09/30/2025 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 pollcy(les) 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($). PRODUCER Calhoun&Associates CONTACT NAME: Carmen Ponce DBA:Integrity Advisors (AtH NN Exr: 800-500-9799 we Ne,714-664-0614 14771 Plaza Drive,Ste C E-MAIL carmen Inte rit advisors.com ADDRESS: g y" Tustin CA 927$0 @l INSURERS AFFORDING COVERAGE NAIC# INSURER A:REPUBLIC INDEMNITY CO OF AMERICA 19739 INSURED William H.Nuesse,M.D.and Mary-Ann Nuesse,D.O. INSURER B: Sunrise Multispecialist Medical Center INSURER C: 867 South Tustin Street INSURER D: ORANGE CA 92866 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDDIYYYY MWDD/YYYY COMMERCIALGENERALLIABILITYLi EACHOCCURRENCE $ 11 CLAIMS-MADE OCCUR DAMAGES(RELATE PREMISES Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ POLICY❑ PRO- ❑ LOC JECT PRODUCTS-COMPIOPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINEDSINGLELIMIT $ Ea accident ANY AUTO BODILY INJURY(Par person) $ OWNED SCHEDULED BODILY INJU AUTOS ONLY AUTOS RY(par accident) $ HIRED NON-OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY per accident UMBRELLALIAB OCCUR DO EACHOCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION ,/ STATUTE OTH AND EMPLOYERS'LIABILITYER A ANYPROPRIETORIPARTNERIEXECUTIVE YIN 256017-04 08/01/2025 08/01/2026 E.L.EACHACCIDENT $1,000,000 OFFICERIMEMBEREXCLUDED9 Y� N I A (Mandatary In NH) E,L.DISEASE-EA EMPLOYEE $1,000,000 It yes,describe under 11,000,000 � O�d o00 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ r r Digitally signed Tu Tr an hyTuTran Nguyen 00 Date:2025.10.07 DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES (ACORD 101.Additional Remarks Schedule,maybe attached it more space is required) ' The Waiver of Subrogation applies to the City of Santa Ana,its City Council,officers,officials,employees,agents,and volunteers. APPROVED By Tu Tran Nguyen at 10:45.am,.Oct Q7.,2,025 CERTIFICATE HOLDER CANCELLATION City of Santa Ana Attention: Human Resources Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 Civic Center Plaza,CA 92701 ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana,CA 92701 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD