CLINICAL LABORATORY OF SAN BERNARDINO

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A - Zotsq. ►%j-o, A� o® CERTIFICATE OF LIABILITY INSURANCE DAM 5/6/2079 I 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 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 Wood Gutmann &Bogart Insurance Brokers License 0679263 15901 Red Hill Ave., Suite 100 CONTACT NAME: Jazmin Chavez PHOAIDNE Extl. 714-450-1660 aIc No: E-MAIL ADDRESS: 'chavez w bib.com INSURII AFFORDING COVERAGE NAIC N Tustin CA 92780 INSURERA: Transportation Insurance Co. INSURED CLINI-2 INSURER B: Continental Casualty Co Clinical Laboratory of San Bernardino, Inc. Geo-Monitor, Inc. INSURERC: Hartford ADD & Indemnity Co INSURER D : Property & Casualty PO Box 329 INSURER E: San Bernardino CA 92402 INSURER F : COVERAGES CERTIFICATE NUMBER: 976023935 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 TR TYPE OF INSURANCE ADOL SUBR POLICY NUMBER MM/DDYA'EYFYY MM/DDYM DPY LIMITS A GENERAL LIABILITY V 6072997663 2/112019 VI/2020 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAM AUE_T0_R_E_NITE0__ PREMISES (Ea occurrence) $100.000 _ CLAIMS -MADE OCCUR MED EXP (Any one person) $10,000 _ PERSONAL B AOV INJURY $1,000.000 GENERAL AGGREGATE $2,000.000 _ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO $2,000.000 POLICY X PRO LOC I 1 1 $ C AUTOMOBILE LIABILITY 72UECHF6015 21112019 2/112020 COMBINED SINGLE LIMIT Ea accident) 000 BODILY INJURY (Per person) $ X ANY AUTO ALL OWNED SCHTOSEDULED AU AUTOS BODILY INJURY (Per accident) $ Werramic nt ROPERTY DAMAGE $ X HIRED AUTOS X AUTOS ED $ A X UMBRELLA LIAB X OCCUR 6076281162 2/1/2019 2/1/2020 EACH OCCURRENCE $5,000.000 AGGREGATE $5.000,000 EXCESS LIAB CLAIMS -MADE DED I X I RETENTION$10.000 S D WORKERS COMPENSATION ANDEMPLOYERVLIABILITY YIN ]2WECAS6a98 2/1/2019 2/i/2020 X VJC STATU- OTH- T RY LIMITS ERANY PROPRIETOFUPARTNER/EXECUTIVE EL EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDEp ❑ NIA E.I. DISEASE - EA EMPLOYEE _ $1.000.000 (Mandatory in NH) If yerib s, describe under DESCRIPTION OF OPERATIONS be. E.L. DISEASE -POLICY LIMIT $1p00.000 B Environmental Professional Liabil EEH2]61]0923 V112019 211/2020 Per Claim 3.000,000 Claims Made Coverage Aggregate 3,20.000 Deductible: $100,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) RE: All Operations usual to the insured's operations subject to the policy terms and conditions 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 and conditions of the policy. r\EVIEWED BY - City of Santa Ana Attn: Water Resources (M-85) 220 S. Daisy Ave Santa Ana CA 92703 SHOULD ANY OF THE ABOVE-DEOC411I860.1CLICt66 BEiAIII-1 I 0.BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. U 19BB-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD