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<br />7146473345 p.2
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<br />Date 4/1/:'008 1113AM Page "~'4
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<br /> CERTIFICATE OF LIABILITY INSURANCE OP 10 N~ OAT!: (MMIOOJVY'('()
<br />ACORD. CLINr-l 04/01/08
<br />PRODUCiOR THIS CERTIFICATE 1$ ISSUED AS A MATTER OF INFORMATION
<br />Andraini & Company-south Coast ONl.V AND c;Ol'ff.e."~ /'10 ftlGHTS UPON THE CERTIFICATE'
<br />License 0208825 HOLDER, THIS CERTifICATE DOES NOT AIlEND, EXTEND OR
<br />One MacArthur Placer Suite 100 Al fER THE COVERAGE AFFOROED BY THE POLICIES BElOW.
<br />South Coast Metro CA !il~701 1
<br />Pbone:114-327-1400 l'ax;714-327-1499 INSURERS AFFOIWtNG COVERAGE l"^~
<br /> -- - -- ----t---
<br />INSURED i I'<o;,;.,~ f.' ~ ~nclnr.uU&~tl'CDlllJ'antot 1_2042'
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<br /> ,"::;_'R~R <; CQnt~Mnh~_ Cu".U_y ~II~.~
<br /> Clini.cal Laboratories of -- I -
<br /> San Bernardino, Inc. r'JSI_I~e::; ,
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<br /> P.O. Box ~29 1 '''''.-l'<t:~ ,~, --j-
<br /> San Bernardino CA 92402 - - - -- - - -
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<br />C;OVERAGE:S
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<br />LIMITS
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<br />WURKERS COMPENSATION ANO
<br />I EMPLOYERS' LI.ll6Ill'ry
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<br />B ! Professional EEA276170923 02/01/Q81 02/0l/0Sl
<br />Liability ("'0) I . __, __ _n I
<br />IlESCRlPTIClN OF OPERATIONS.; LOCATIONS I VEHiCLES J EXCI USIONS. AOOEO BY ENtlORSE/.I:NT I SPECIAL PRC'JI'lIONS
<br />+.REVrSES * REPLACES CERTIFICATE ORIGlNALL~ ISSUED 02/15/08**
<br />Certificate Holder is additional insured as respects to General Liability
<br />per written contract per attached G-l?957-G99.
<br />The CANCELLATION notice herein is amended to ro~d 10 deY3 as ~espects any
<br />cancellation due to non-payment o~ premiwm.
<br />
<br />CERTIFICATE HOLDER
<br />
<br />CANCELLATION
<br />
<br />SI-'OULO AI\IY OF THl': JlI'lCiVE OESCRIRED POlICIES liE CANCELLED BeFORE TI4' EXPIRATION
<br />
<br />CAYS WRITTEN
<br />
<br />CITYSAA
<br />
<br />claim/A;g
<br />Deduct.
<br />
<br />3,000,000
<br />100,000
<br />
<br />UATE THEREOF. THl<lss~r>;G 'NSUA.ER WLL ErmEAVOR TO MAil 30
<br />
<br />.'lonCE TO THE CERTlFiCAll "'OL:JERNAMEO T01HE LEfT. BUT FAILURE TO 00 $0 SHAll
<br />
<br />City of Santa Ana
<br />Department Of Public Works
<br />220 S. Daisey Ave.
<br />Santa Ana CA 92703
<br />
<br />IMPOSE NO 08UGATJON C,f'1lI118ILITV OF ANY KIND UPON THE INSURER, ITS AG<=NTS OR
<br />
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<br />ACORD 25 (20D1!1l8)
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