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2020/08/01 Thinknetic Medical Corporation Keystone Industrial Medicine 57769597 DocuSign Envelope ID:27434D5D-1AO6-4B37-AD2F-D34AODF33D36 79/25/2020 E(MMIDDYYY) A�" CERTIFICATE OF LIABILITY INSURANCE IY 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). CONTACT PRODUCER Patriot Risk& Insurance Services NAME: 2415 Campus Drive, Suite#200 AICNE Ext: 949 486-7900 (A/C,No: Irvine, CA 92612 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# www.patrisk.com OK07568 INSURERA: Sentinel Insurance Company, Ltd. 11000 INSURED INSURER B: Hartford Insurance Co of the Midwest 37478 Thinknetic Medical Corporation INSURERC: National Fire&Marine Insurance Co 20079 Keystone Industrial Medicine 1950 S. Sunwest Lane Ste 108 INSURERD: San Bernardino CA 92408 INSURERE: 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DDIYYYY MM/DDIYYYY A COMMERCIAL GENERAL LIABILITY 72SBABC2677 8/1/2020 8/1/2021 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED V CLAIMS-MADE1:1 OCCUR 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 ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED ✓ AUTOS ONLY L11 AUTOS ONELY D (pRar C.,dTnDAMAGE $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION 72WECAD5ZBC 8/1/2020 8/1/2021 ,/ STATUTE OERH AND EMPLOYERS'LIABILITY Y I N ANYPROPRIETOR/PARTNER/EXECUTIVE 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 8/1/2021 Per Event Limit:$1,000,000 (Claims Made) Aggregate Limit:$2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Thinknetic Medical Corporation 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) 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