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l D'9'ta°y signed by Francine R. Villareal <br />Francine R. Villarea <br />Date: 2021.02.08 13:16:46-08'00' <br />ACCORD® CERTIFICATE OF LIABILITY INSURANCE <br />r DATE(MM/DD/YYYY) <br />Ill <br />2/1/2021 <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 endorsement(s). <br />PRODUCER <br />CONTACT <br />NAME: Melissa Ignells <br />Wood Gutmann & Bogart Insurance Brokers <br />PHONE <br />License 0679263 <br />A/c No Ext: 714-450-1669 p/X No: <br />ADMDRESS: mignelis@wgbib.com <br />15901 Red Hill Ave., Suite 100 <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />Tustin CA 92780 <br />INSURERA: Continental Casualty Co <br />INSURED CLINI-2 <br />INSURERB: Hartford ACC & Indemnity Co <br />Clinical Laboratory of San Bernardino, Inc. <br />Geo-Monitor, Inc. <br />INsuRERc: American Cas Co of Reading PA <br />20427 <br />INSURERD: Continental Insurance Company <br />PO Box 329 <br />San Bernardino CA 92402 <br />INSURERE: Hartford Underwriters Ins Co <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: 69885336 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 />INSR <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />INSR <br />SUBR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MMIDD/YYY <br />POLICY EXP <br />MMIDD/YYY <br />LIMITS <br />C <br />GENERAL LIABILITY <br />Y <br />6072997663 <br />2/1/2021 <br />2/1/2022 <br />EACH OCCURRENCE <br />$ 1,000,000 <br />X COMMERCIAL GENERAL LIABILITY <br />DAMAGE ( RENTED <br />PREMISESS Ea occurrence) <br />$ 100,000 <br />CLAIMS -MADE OCCUR <br />VIED EXP (Any one person) <br />$ 10,000 <br />PERSONAL & ADV INJURY <br />$ 1,000,000 <br />GENERAL AGGREGATE <br />$2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGG <br />$ 2,000,000 <br />PRO- <br />POLICY X JECT X LOC <br />$ <br />B <br />AUTOMOBILE <br />LIABILITY <br />72UECHF6015 <br />2/1/2021 <br />2/1/2022 <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$ 1 000 000 <br />X <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY (Per accident) <br />$ <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />NON -OWNED <br />HIRED AUTOS AUTOS <br />D <br />X <br />UMBRELLA LAB <br />X <br />OCCUR <br />CUE 6076281162 <br />2/1/2021 <br />2/1/2022 <br />EACH OCCURRENCE <br />$ 5,000,000 <br />AGGREGATE <br />$ 5,000,000 <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED X RETENTION $ 10,000 <br />$ <br />E <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />72WECAE9FU9 <br />2/1/2021 <br />2/1/2022 <br />X WCSTATU- OTH- <br />TORY LIMITS ER <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />E.L. EACH ACCIDENT <br />$ 1,000,000 <br />OFFICER/MEMBER EXCLUDED? ❑ <br />N /A <br />E.L. DISEASE - EA EMPLOYEE <br />$ 1,000,000 <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$ 1,000,000 <br />A <br />Environmental Professional Liabil <br />276170923 <br />2/1/2021 <br />2/1/2022 <br />Per Claim 3,000,000 <br />Claims Made Coverage <br />Aggregate 3,000,000 <br />Deductible: $100,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <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 CNA75081 XX(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 Non -Contributory applies on the General Liability per attached <br />CERTIFICATE HOLDER CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, <br />NOTICE WILL <br />BE DELIVERED IN <br />City of Santa Ana <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Risk Management Division <br />20 Civic Center Plaza, 4th Floor <br />AUTHORIZE -,REPRESENTATIVE <br />Santa Ana CA 92701 <br />1°x <br />Risk Managzrrtenti?iviaian <br />REVIEWED &APPROVED SY: <br />P, <br />@ 1988-2010 ACORD C4 <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <br />_ _— <br />Wsk Management Analyst <br />