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A� d CERTIFICATE OF LIABILITY INSURANCE <br />DAM(M 020 <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 policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terns 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 endorsement(s). <br />PRODUCER <br />Wood Gutmann & Bogart Insurance Brokers <br />License 0679263 <br />15901 Red Hill Ave., Suite 100 <br />ANT"S. T Melissa 4 neIIS <br />PHONE 714-450-1669 F"'I <br />U-N <br />MD DAIL. mi nelis bib.com <br />Tustin CA 92780 <br />INSLIFIER(SI AFFORDING COVERAGE <br />NAIC I <br />INSURER A: Continental Casualty Co <br />INSURED j CUNI.2 <br />Clinical Laboratory of San Bernardino, Inc. J/ <br />Geo-Monitor, Inc. <br />INSURER B: Hartford ACC S Indemnity CO <br />INSURER c: American Cas Co of Reading PA <br />20424 <br />WsuRER o : Continental Insurance Company <br />PO Box 329 <br />San Bernardino CA 92402 <br />INSURER E : <br />INSURER F <br />COVERAGES CERTIFICATE NUMBER: 1004373250 REVISION NUMBER - <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 />ILTR NSR <br />TYPE OF INSURANCE <br />ADDL <br />POLICY NUMBER <br />MOLIDYEFF MIODAYYYI <br />MMIDDPOLIC <br />LIMITS <br />C <br />GENERAL LIABILITY <br />Y <br />607M)7683 <br />V1I2020✓/ / <br />Lt/2 221- <br />EACH OCCURRENCE <br />51,0MIXIO <br />X COMMERCIAL GENERAL LIABILITY <br />//PREMISES <br />jE, <br />$IODOX <br />MED EXP (My we <br />S10.000 <br />CLAIMS-MADElil OCCUR <br />PERSONAL & ADV INJURY <br />S 1000,000 <br />GENERAL AGGREGATE <br />S2,000.000 <br />GENL AGGREGATE <br />LIMIT APPLIES PER <br />PRODUCTS -COMPIOP AGG <br />$2.000,000 <br />POLICY <br />1( PRO- <br />ECT X LOC <br />$ <br />8 <br />AUTOMOSILELIABILRY <br />/ <br />72UECHFW15 <br />2/11=0 <br />V1Q021 <br />COMBINED SINGLE LIMIT <br />X <br />ANY AUTO 1! <br />AUTOOS A�ODULED <br />/ <br />J <br />B000.V INJURY (Px Peraan) <br />S <br />BODILY INJURY (Pw acddent) <br />S <br />NONED <br />HIREDAUTOS ATOS <br />PROPERTY <br />$ <br />E <br />D <br />X <br />UMBRELLALIAB <br />X <br />OCCUR <br />CUE6076281162 <br />2112020 <br />211r2021 <br />EACH OCCURRENCE <br />55000.000 <br />AGGREGATE <br />SE,000ODO <br />EXCESS LIAR <br />I CLAIMS -MADE <br />DEO I X I RETENTIONS 10000 <br />S <br />8 <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITYM <br />YIN <br />72`AECAESFUS <br />WO020 <br />2/t� <br />X WC STATU- OTH- <br />ER <br />E.EACH ACCIDENT <br />L <br />$IODO,000 <br />ANY PROPRIETORIPARTNERECUTNE E <br />OFFICERIMEMBER EXCLUDED? ❑ <br />NIA <br />EL DISEASE - EA EMPLOYE <br />S1,000,000 <br />(ManNNNy In NH) <br />N yyeeae deavibe under <br />DESCRIPTION OF OPERATIONS below <br />EL DISEASE -POLICY LIMIT <br />S1.0o0,000 <br />A <br />Emaon WPr nsional Labil <br />Cwrns Da Nee.. SIM.OW / <br />EEK276IMS23 <br />V1r2020 <br />✓ <br />27 <br />Per Crone 3.000,000 <br />AgBrepete 3.OW.000 <br />DESCRIPTION OF OPERATIONS I LOCATONS I VEHICLES (Attach ACORD 101. Addidwal Ramaras Schedule, H man apue la neulred) <br />RE: All Operations usual to the insured's operations subject to the polity terms and conditions <br />Certificate holder is named as additional insured on the General Liability per attached CNA7508 1XX(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 carrier. <br />Pnmary and Non -Contributory applies on the General Liability per attached <br />CERTIFICATE HOLDER CANCELLATION <br />BY Risk MANAGEMENT DIVI <br />IOiHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />/ <br />YItE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />City of Santa Ana ✓ pp <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Risk Management Division APR 20 <br />AUTHONIZE EPRESENTATWE <br />20 Civic Center Plaza, 4th Floor <br />Santa Ana CA 92701 <br />ANff1E ACEVECIO <br />©1988-2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD <br />