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acoRO CERTIFICA' ' OF LIABILITY INSURA~''E WES1bCCY DA 09M25 0' <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />Dodge Warren 6 Peters - ORANGE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />Lic . #0543695 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />765 The City Drive, Suite #300 ALTER THE COVERAGE AFFORDED 8Y THE POLICIES BELOW. <br />Orange CA 92868- <br />Phone:714-748-0464 Fax:714-748-0474 INSURERS AFFORDING COVERAGE NAIC# <br />INSUaeu INSURER A: Royal suzpiva Lies iv. co. <br />Westcliff Medical Laboratories <br />Inc. , Golden Coast INSURER B'. <br />Laboratories, Inc., The <br />Medical Center Laboratory INSURER C: <br />15D1 StlperlOr AVe. INSURER D: <br />Newport Seach CA 92663 Q ~~~-/5.,,yd <br />INSIIRFR F <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANV CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAV BE ISSUED OR <br />MAV PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO All THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BV PAID CLAIMS. <br />LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/OD/YY DATE MM/DD/YY LIMITS <br /> GENERAL LUIBILITY EACH OCCURRENCE f <br /> <br />i <br />COMMERCIAL GENERAL LIABILITY ETOTtEI <br />PREMISES (Ea acmrence) <br />$ <br /> CLAIMS MADE ~ OCCUR MED EXP (Any one parson) $ <br /> PERSONAL 8 ADV INJURY $ <br /> GENERAL AGGREGATE $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG f <br /> POLICY PRO- LOC <br />JECT <br /> AUT OMOBILE LIABILITY <br />COMBINED SINGLE LIMIT <br />$ <br /> ANY PUTO (Ea accitlent) <br /> ALL OWNED AUTOS BODILY INJURY <br />$ <br /> SCHEDULED AUTOS (Per person) <br /> HIRED AUTOS <br />BODILY INJURY <br />$ <br /> NON-OWNED AUTOS (Par accitlenl) <br /> PROPERTY DAMAGE <br /> <br />(Per accitlenl) $ <br /> GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ <br /> ANV AUTO OTHER THAN EA ACC E <br /> i~j E'OR AUTO ONLY: AGG $ <br /> EXCESS/UMBRELLA LIABILITY ~''>I EACH OCCURRENCE $ <br /> OCCUR ~ CLAIMS MADE AGGREGATE $ <br /> $ <br /> hC"3y <br /> DEDUCTIBLE L,1- [.l <br />, $ <br /> ' (;l[y Alt`I I <br />-~~~ <br /> RETENTION $ f U(} E <br /> WORKERS COMPENSATION AND TORY LIMITS ER <br /> EMPLOYERS' LUIBILITY <br /> ANY PROPRIETORIPARTNER/EXECIi TIVE E.L. EACH.4CCIDENT <br /> OFFICER/MEMBER EXCLUDED? E.L. DISEASE-EA EMPLOYEE $ <br />-- - <br /> It yas, tleacnba untler <br /> SPECIALPROVISIONSDeIOw E.L. DISEASE-POLICY LIMIT $ <br /> OTHER <br />A Professional K2FAS801656 08/31/03 08/31/04 1,000,000 Occurrence <br /> Liabilit 3,000,000 A re ate <br />DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES / E%CLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS <br />RE: Verification of Insurance. *Except 10 day notice of cancellation <br />for non-payment of premium. <br />CERTIFICATE HOLDER CANCELLATION <br />City of Santa Ana <br />Attn: Roberta <br />20 Civic Center Plaza <br />Santa Ana CA 92702 <br />C-SANTA SHOULD ANY OF THE ABOVEbESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO'i <br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3O * DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 30 SHALL <br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UP~yON THE INSURER, ITS AGENTS OR <br />REPRESENTATIVES. // ~ ~/ / <br />ACORD 25 (2001/08) <br />