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CERTIFICATE OF LIABILITY INSURANCE <br />OATC (mm'DONYYVI <br />O6/fl <br />THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFPIRMATIVELY 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 INSURERS), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the cortlflpnta holder Is an ADDITIONAL INSURED, the policy(Ias) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this Certificate does not confer I'Ights to the <br />certbloate holder In )leu of SUCH ondorsoment s <br />PRODUCER CONTACT Kim Garton <br />NAME: <br />Lords Insurance Agency Inc PHONE 714-4075481 714.902-0574 <br />1Alc nmI <br />P.O, Box 4419 EMAIL —" <br />aDPEss: kine@Ioraslnsurance.com <br />Huntington Beach, CA 92605 <br />License #: OC60256 INSURER(g) AFFOROINC COVERAGE NAICA <br />INSURER A: Golden Eaule Insurance Corp_______ <br />INSUReD INsuRER s: Hartford Insurance G uD <br />22357 <br />Y <br />Sano Medical Center Inc. James Stirbl Trust INSURER.0 r <br />BZS(15)56154276 <br />700 W 19th St INSUKER D I <br />06)90/2016 <br />Costa Mesa,. CA 92627 INsuaeR E : <br />DAMAGE TO RE TED <br />., SEs ...,11W a 300,000 <br />IN90RF0. F <br />nnVFR an PR rtFRTIFInaTP MI IMRFR, nnnnnnnn.946A PP RFVIAInN N1IMRRR• R <br />THIS IS TO CERTIFY THAI' THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTIMT'HSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE. MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY I'HE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.. <br />ILTRNR <br />TypE OE.INSUPANCE <br />�POLICIES, <br />POLICY NUM1IEER <br />WAf100mYV <br />POLICYogy?` <br />_ <br />LIMITS <br />A <br />x CONNICRGIAL GENCRAL LIABILITY <br />tl WM3MAUe" ® OCCUR <br />Y <br />BZS(15)56154276 <br />0613012016. <br />06)90/2016 <br />EAOHCCCURRSNCB a 1.000.000 <br />DAMAGE TO RE TED <br />., SEs ...,11W a 300,000 <br />MED EXF.ky o..loon) 6 15,000 <br />_ <br />PERSONAL L ADV INA RY 8 1000000 <br />dEML AGGREGATE LIMIT APPLIES PSR: <br />GENERALAGOREGATE 6 2000 000 <br />. JX POLICY ❑ JrCTPRO. ❑ LOC <br />_ <br />PRODUCTS COMP(OPAGG 8 2 OOD 000 <br />OTHER: <br />A <br />AUTOM1tOBILE <br />LIASILItt <br />7 <br />BZS(15j56154276 <br />06190)2015 <br />Os/90/z01s <br />COM811ED SINGLE HMR S <br />_(I& i-0-0-0-0-0 —0 <br />IODIILY I NJURY IN, peiocU b <br />ANYAUTO_ <br />_ <br />_ <br />}( <br />AUTOS NEO AUT,OEDULEO <br />HIRER Atfi06 )( NON CIANEDPRbPEhTY <br />AUTOS <br />_ <br />8OQIL'/INJiiRY(PeraadabnN S <br />WIelAOI, 6 ' <br />(P? rv'tlnn <br />S <br />UMBRELLA LIARCCUR <br />( <br />EACH OCCURRENCE S <br />AGGREGATE 6 <br />EXCESS LIAR BMW FIADE <br />_ <br />5 <br />DEO REL'=NTION9 <br />B <br />AnoeERR6 COMPENSATION^` <br />ANY PROPRIETORIPARTPEMEXECUTIVE. Y�NIA <br />OPRCERIMEMBER EXCLUDED? <br />(Mundntary In NHl <br />57WECGA4371 <br />0¢!2912014 <br />D61Y3/2015 <br />X PERsrATurE °a"" <br />EL EACH ACCIDENT__ S 11000AOD <br />E.L. DISEASE EA 001 GYM S 1 000,000 <br />DESCRIPTIION OF bc OPERA TIONS? Slow <br />E.L. CI9EAEE-POLICY LIMIT S 1.000,000 <br />OESCRI PTION or OPERATIONS I LOCATIONS I VEHICLES (Adorn)101, Aatllaonnl Run,arNs 31111 la,,nay NellmAm, If mora spoex is maulmd) F <br />Certiflcste Holder Is listed as additional Insured with written contractTO <br />Certificate Holder, Its Officer, agent and employees are names as addltonal Insured In regards to General Llajpyl�l'�sv <br />attached CO 201511/06" <br />20 Oays notice of cancellation for non pay/� r f. <br />�•, 9 yOP�Ot <br />\5P <br />CERTIFICATE HOLDER CANCELLATION P-"'" <br />City Of Santa Ana <br />Attn: Purchasing department <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />TI IE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE Win'H THE POLICY PROVISIONS. <br />1444 S Main St <br />Santa Ana, CA 92707 <br />AUTHORIZED REPREa 4TATj <br />KIO <br />©1988-2014 ACORD CORPORATION, All rights reserved. <br />ACORD 25 (2014(01) The ACORD name and logo Pro registered marks of AOORD <br />Printed by ILIO on June 24, 20'18 at 0097AM <br />Exhibit C <br />