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2021/08/01 Thinknetic Medical Corporation Keystone Industrial MedicineSHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 8/18/2021 Patriot Risk & Insurance Services 2415 Campus Drive, Suite #200 Irvine, CA 92612 (949) 486-7900 www.patrisk.com 0K07568 Sentinel Insurance Company, Ltd.11000 Hartford Insurance Co of the Midwest 37478 National Fire & Marine Insurance Co 20079 A 1,000,00072 SBA BD3214 8/1/2021 8/1/2022 1,000,000 10,000 3 1,000,000 2,000,000 2,000,000 A 72 SBA BD3214 8/1/2021 8/1/2022 1,000,000 3 3 B 72WECAD5ZBC 8/1/2021 8/1/2022 3 1,000,000 1,000,000 1,000,000 C Professional Liability HN044440 8/1/2021 8/1/2022 Per Event Limit: $1,000,000 (Claims Made)Aggregate Limit: $2,000,000 Dave Jacobson 3 Thinknetic Medical Corporation Keystone Industrial Medicine 1950 S. Sunwest Lane Ste 108 San Bernardino CA 92408 63406522 Proof Of Insurance 63406522 | 21-22 GL/WC/PL | Liz Ibarra | 8/18/2021 12:50:55 PM (PDT) | Page 1 of 1 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) "C" Professional Liability Endorsement of Coverage: Jeffrey Lynn Cox, PA DocuSign Envelope ID: 7A3F04E0-31CC-4F90-B7AC-CD29AD43B18E Issuing Company: National Fire & Marine Insurance Company Omaha, Nebraska 1101-PXX-00-1215 Page 1 of 1 © 2015 MedPro Group. All rights reserved. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Endorsement No.: 3 Forming Part of Policy No.: HN044440 Issued to: Thinknetic Medical Corporation Effective Date of Endorsement: 08/01/2021 at 12:01 a.m. at the address of the First Named Insured stated herein. CHANGE ENDORSEMENT In consideration of the payment of the additional premium due, if any, and in reliance upon the representations of all insureds, the company and the insureds agree to amend the policy as follows: The following person(s), organization(s) or location(s) are added to the Schedule of Named Insureds – Professional Liability SCHEDULE OF NAMED INSUREDS NAMED INSURED ID NUMBER RETRO- ACTIVE DATE TERMIN- ATION DATE LIMITS OF LIABILITY (PER EVENT LIMIT/ AGGREGATE LIMIT) RETENTION (PER EVENT/ AGGREGATE) PREMIUM Providers: Jeffrey Lynn Cox 1746113 08/01/2021 $1,000,000 / $3,000,000 $Nil / $Nil $ 954 * Indicates any applicable surcharges, taxes or fees. Premium Adjustment: $ 954 Additional Premium All other terms and conditions of the policy remain unchanged. DocuSign Envelope ID: 7A3F04E0-31CC-4F90-B7AC-CD29AD43B18E