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2020/08/01 Thinknetic Medical Corporation Keystone Industrial Medicine Certificate of Liability Insurance (5)DocuSign Envelope ID: 27434D5D-1AO6-4B37-AD2F-D34AODF33D36 / A� " CERTIFICATE OF LIABILITY INSURANCE DATE'MMIDDIYYYY) g/25/2020 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 Patriot Risk & Insurance Services CONTACT NAME: 2415 Campus Drive, Suite #200 Irvine, CA 92612 ACNE Ext: 949 486-7900 (A/C, No: E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Sentinel Insurance Company, Ltd. 11000 www.patrisk.com OK07568 INSURED Thinknetic Medical Corporation Keystone Industrial Medicine INSURER B : Hartford Insurance Co of the Midwest 37478 INSURERC: National Fire & Marine Insurance Co 20079 1950 S. Sunwest Lane Ste 108 INSURERD: INSURERE: San Bernardino CA 92408 INSURER F : COVERAGES CERTIFICATE NUMBER: 57769597 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MM/DDIYYYY LIMITS A COMMERCIAL GENERAL LIABILITY 72SBABC2677 8/1/2020 8/1/2021 EACH OCCURRENCE $1,000,000 V CLAIMS-MADE1:1 OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY ❑ PRO - POLICY ❑ LOC ✓ PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: A AUTOMOBILE LIABILITY 72SBABC2677 8/1/2020 8/1/2021 EOaBINEDtSINGLELIMIT $1,000,000 BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ ✓ (pRar C.,dTnDAMAGE $ HIRED AUTOS ONLY L11AUTOS ONELY D UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE 72WECAD5ZBC 8/1/2020 8/1/2021 ,/ STATUTE OERH E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 C Professional Liability HN044440 8/1/2020 811/2121 Per Event Limit: $1,000,000 (Claims Made) Aggregate Limit: $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION Thinknetic Medical Corporation SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Keyystone Industrial Medicine ACCORDANCE WITH THE POLICY PROVISIONS. 1950 S. Sunwest Lane, Suite 108 San Bernardino CA 92408 AUTHORIZED REPRESENTATIVE Dave Jacobson U ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 57769597 1 20-21 GL/WC/PL I Liz Ibarra 1 9/25/2020 9:57:52 AM (PDT) I Page 1 of 1