CLINICAL LABORATORY OF SAN BERNARDINO

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A� " CERTIFICATE OF LIABILITY INSURANCE Dnr2/13/2018 Y) 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 CONTACT NAME: Carrie Clark CIBC Insurance Services LLC PHONE License #OK19767 . 310-981-0801 NC No: LE,U E-MAINo ADDRESS: carrie.clark@crystalco.com 32 Old Slip New York NY 10005 INSURERS AFFORDING COVERAGE NAIC0 INSURER A: Hartford Underwriters Insurance Company 30104 INSURED CUNLA INSURER B: Transportation Insurance Company 20494 CIInICaI Laboratory Of San Bernardino, Inc. P.0 Box 329 ContinentalNSURER C: Continental Casualty Company 20443 INSURER D: Hartford Accident and Indemnity Company22357 San Bernardino CA 92402 INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: 502710517 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 AINSD OOL 9UBR D POLICYNUMBER MMICYEEFF MMIDDIYYYY LIMITS B 4COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � Y Y 5088208188 21112018 2/1/2019 EACHOCCURRENCE $1,000,000 PREMISES ES RENTED PREMIS Ea occurrence $100,000 MED EXP (Any one person) $ 5.000 PERSONAL &ADV INJURY $1,000,000 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 GEN'L POLICY ❑ jECT [X] LOG PRODUCTS - COMPIOP AGO $2,000,000 $ OTHER: D AUTOMOBILE LIABILITY 1OUECHF6015 2/112018 2/1/2019 COMBINED SINGLE LIMIT Ea accident $ 000000 BODILY INJURY (Pan person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Par accident) $ HIRED NON�OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per eccldenl $ B X UMBRELLA LIAB X OCCUR 6046009225 2/112018 2/1/2019 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 EXCESS LIAB CLAIMS -MADE CEO X RETENTION$ l000n $ A WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN 10WECAS6498 21V2018 2/112019 X STATUTE �RH E, L. EACH ACCIDENT $1,000,000 ANYPROPRIETORIPARTNEWEXECUTIVE [Y] OFFICERIMEMBER EXCLUDED? NIA E. L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 C Professional Llabllity, and Pollution Incident Llabllity, EEH276170923 2/1/2018 2/1/2019 Each Claim/Aggregate 3,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AC ORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Consultant Agreement Extension. City of Santa Ana, it's officers, employees, agents and representative are included as additional insured as required by written contract with the named insured as respects General Liability coverage per the terms and conditions of the policy. Waiver of subrogation applies in favor of the certificate holder per the terms and conditions of the policy. 30 Day Notice of cancellation is granted in favor of the certificate holder. 7P4.c (1 7 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Public Works Agency 20 Civic Center Plaza M-36 AUTHORIZED REPRESENTATIVE P.O. Box 1988 M-36 Santa Ana, CA 92702 Z,.,. >. L L C' © 1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD