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A� d CERTIFICATE OF LIABILITY INSURANCE <br />°";;Z,o2o ' <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY 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 INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(ies) 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 rights to the <br />certificate holder in lieu of such endomement(s). <br />PRODUCER <br />Wood Gutmann & Bogart Insurance Brokers <br />License 0679263 <br />15901 Red Hill Ave., Suite 100 <br />CONTACT <br />NAME Melissa nelis <br />PHONE FAX <br />7144450-1669 <br />Apwp`N'ESS mipnelisOwclbb.com <br />Tustin CA 92780 <br />INSURE S AFFORDING COVERAGE <br />NAIC a <br />INSURER A: Continental Casualty Co <br />INSURED / CUNI-2 <br />Clinical Laboratory of San Bernardino, Inc. J <br />Geo-Monitor, Inc. <br />INSURER B: Hartford ACC & Indemnity CO <br />INSURER c :American Cas Co of Reading PA <br />20424 <br />INSURER D : Continental Insurance Company <br />PO Box 329 <br />San Bernardino CA 92402 <br />INSURER E: <br />INSURER F <br />COVERAGES CERTIFICATE NUMBER: 1004373250 REVISION NUMBFR- <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />ILp <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POLICYEF <br />MWDDr(YYYI <br />POLICY EXP <br />RAMIDDA'YYY1 <br />LIMITS <br />C <br />GEREML LIABILITY <br />Y <br />6072997663 <br />V12020/ <br />2/1/202L <br />EACH OCCURRENCE <br />E1,000,D00 <br />%t COMMERCIAL GENERAL LIABILITY <br />✓/ <br />I/ <br />PREMISES <br />E1oD,DDO <br />MED EXP (My we <br />$10pDO <br />CLAIMS -MADE F—X� OCCUR <br />PERSONAL & ADV INJURY <br />$1,000,000 <br />GENERALAGGREGATE <br />$2A00000 <br />GENT AGGREGATE <br />LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGG <br />S2,ODQ000 <br />17 POLICY <br />X PRO- X LOC <br />$ <br />B <br />AUTOMOBILE <br />LIABILITY / <br />72UECHFW15 <br />V12020 <br />2/1/2021 <br />COMBINED SINGLE LIMII <br />Ea accident) <br />S 1000 We <br />ANY AUTO v <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />/ <br />•/ <br />BODILY INJURY person) <br />S <br />n <br />BODILY INJURY (Peraaitlanp <br />E <br />PR PERTY DAMA <br />$ <br />HIRED AUTOS "NaJ�NT1ED <br />E <br />D <br />X <br />UMBRELLA LIAB <br />X <br />OCCUR <br />CUEW76281162 <br />2112020 <br />2112021 <br />EACH OCCURRENCE <br />$ 5,000.000 <br />AGGREGATE <br />E5,0D0,D°0 <br />E%CESSLIAB <br />CLMMS-MADE <br />DED X RETENTION 10000 <br />$ <br />B <br />WORKERS COMPENSATION <br />IEXAND EMPLOYERS' LIABILITY <br />ANY PROPRIETOR/PARTNERECUTIVE YI❑N <br />72WECAE9FU9 <br />WirMo <br />2/12021 <br />X WCSTATD' OTH- <br />E.L. EACH ACCIDENT <br />S1,000,000 <br />OF E%CWDED? <br />NIA <br />EL DISEASE - EA EMPLOYEE <br />$1,000,000 <br />(Mandatory In NH) <br />If yyes. descr or under <br />DESCRIPTION OF OPERATIONS Delve <br />E.L. DISEASE -POLICY LIMIT <br />$1,000,000 <br />A <br />Er mmmerdal Prom8siunal Liabd <br />Clams Made Coverage <br />DeducDNe.$100,000 <br />EEH276170923 <br />V12020 <br />2/1207X <br />/ <br />Per Claim 3.0°0,0°0 <br />Aggregate 3,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101. AddlOonal Remarks Schedule, it more space Is mquirsd) <br />RE: All Operations usual to the insured's operations subject to the policy terms and conditions <br />Certificate holder is named as additional insured on the General Liability per attached CNA75081XX(1.15) as required by written contract subject to the terms <br />and conditions of the policy. <br />Certificate of Insurance shall provide thirty (30) day prior written notice of cancellation per form to follow from carder. ./ <br />Primary and Non -Contributory applies on the General Liability per attached <br />MA <br />City of Santa Ana 1✓ <br />Risk Management Division <br />20 Civic Center Plaza, 4th Floor <br />Santa Ana CA 92701 <br />�K MANAGEMENT DIVI IOCOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />E EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />APR U 202o 1 <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />ACEVEdO <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <br />