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'`� d CERTIFICATE OF LIABILITY INSURANCE <br />°"T412, 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 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 endorsements). <br />PRODUCER <br />Wood Gutmann 8 Bogart Insurance Brokers <br />License 0679263 <br />15901 Red Hill Ave., Suite 100 <br />courA r Melissa) nelis <br />PNONE . 714-agnelis 9 F"% <br />E#1AlL <br />mi nelis bib.com <br />Tustin CA 92780 <br />INSURE S AFFORDING COVERAGE <br />NAIL e <br />INSURER A: Continental Casualty Co <br />INSURED / CLINI-2 <br />Clinical Laboratory of San Bernardino, Inc. J/ <br />Geo-Monitor, Inc. <br />INSURER B: Hartford ACC g Indemnity Cc <br />INSURER c: American Cas Co of Reading PA <br />20424 <br />PO Box 329 <br />San Bernardino CA 92402 <br />INsuRER o : Continental Insurance Company <br />INSURER E: <br />_ <br />INSURER F : <br />COVERAGES CFRTIFICATF MI IMRFR- lnn,11719Gn DcvlmnM .. <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 <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />MMII�IYEYFYY <br />M UY� <br />y <br />LIMITS <br />C <br />GENERAL LIABILITY <br />Y <br />W72997665 <br />V1=20/ <br />EACH OCCURRENCE <br />SI.CCO(W <br />X COMMERCLILGENERAI LUABILRY <br />CLAIMS -MADE a OCCUR <br />✓/ <br />/ <br />R p <br />$1WDOD <br />MED EXP (My one persD+ <br />$ 10,01x) <br />PERSONAL S ADV INJURY <br />I100GAOG <br />GENERAL AGGREGATE <br />I2.000AW <br />GENL AGGREGATE LIMIT APPLIES PER <br />PRODUCTS -COMPIOP AGG <br />S2.DX)WG <br />POUCY X jFr PRO- X LOC <br />f <br />8 <br />AUTOMOBILE <br />LIABILITY / <br />72UECHFW15 <br />El11020 <br />2`1=1 <br />COMBINED SINGLE LIMIT <br />ANY AUTO 1/ <br />ALL OWNED SCHEDULED <br />AUTDB AUTOS <br />/ <br />I <br />X <br />BODILY IMURY(Per parson) <br />S <br />BODILY INJURY (Per amiden0 <br />f <br />HIRED Atr05 AUTOS <br />1Y E <br />f <br />f <br />D <br />X <br />UMBRELLA UAS <br />X <br />OCCUROCCURQlE6G76281162 <br />21112020 <br />VICo21 <br />EACHOCCURRENCE <br />$5,=,000 <br />AGGREGATE <br />f5,00°,000 <br />EXCESS LW <br />CLAIMS -MADE <br />DIED I X I RETENTION s 111 <br />f <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS UJA91LITY <br />ANY PROPRIETORIPARTNERE ECUTIVE YIN <br />OFHCERMEMSER EXCLUDED? ❑ <br />NIA <br />RWELAE9FU9 <br />2112020 <br />2711� <br />X WC STATU- DTI+ <br />EL EACH ACCIDENT <br />$i== <br />E.L DISEASE -EA EMPLOYE <br />StDaD000 <br />(MMgalor, 1^NNI <br />do deem aawder <br />EL DISEASE -POLICY LIMIT <br />St,000,0W <br />DESCRIPTION OF OPERATIONS below <br />A <br />Enviom WPmfass.I Uadl <br />Cla. Mach Coverage � <br />owbvt, e. SiWp00 <br />EEH27617W23 <br />2/1/2020 <br />L1rt°2Y <br />/ <br />Per Claim ],O = <br />A9pregete 3,OW.WO <br />DESCRIPTION OF OPERATIONS I LOCATIONS IVEHICLES (Aastl1 ACORD 101. A4419mal Rsm ks f hWuls, 9 man apace Is requlrad) <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 Carrier. <br />Primary and Nan -Contributory applies on the Gepeial Liability -per attached <br />CERTIFICATE HOLDER C-111MCF1 I ATInM <br />By RISk MANq('jEMENT DIN <br />I„A}IOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />// <br />o tE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />City Of Santa Ana 1/ ,� pppp <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Risk Management Division !1f R ZQ <br />AUTHORIZE EPRESENTATNE <br />20 Civic Center Plaza, 4th Floor - <br />Santa Ana CA 92701 <br />©1988-2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <br />