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<br />OP ID VJ DATE (MMlDDIYYYY)
<br />CLINI-1'&1 05/31/07
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
<br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
<br />
<br />~CORD,.
<br />
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />
<br />PRODUCER J
<br />Andreini & Company-South Coast
<br />
<br />License 0208825
<br />One MacArthur Place,
<br />South Coast Metro CA
<br />Phone: 714-327-1400
<br />-- .'_., , .- -,
<br />INSURED
<br />
<br />Suite 100
<br />
<br />92707 '
<br />!,a~~?14 ~327_~14!_9___ IINS.'-IRER~ AFFORDING ~OVE~GE '._.
<br />
<br />~URER A. American Casual ty Company of
<br />A - ~C03 -~ ;;WRE; B -. Zeni th Insur~nce Company
<br />A ....1cC)j -.;lj9~~U!,ER~_='-==--=- ==-=-=-_
<br />
<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 ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
<br />MAY 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 BY PAID CLAIMS,
<br />
<br />"" ---."~- -~- POL'IC"y' NUMB-ER ~ ---I POLICY EFFECTIVE" rpQ[iCv EXPIRATION I
<br />TYPE OF INSURANCE ' DATE (MMIDDIYY DATE (MMIDDIYY)
<br />
<br />GENERAL LIABILITY I
<br />
<br />A X! X! COMMERCIAL GENERAL LIABILITY TCP2068975201 02/01/07 02/01/08
<br />
<br />, ,. 'CLAIMS MADE [}c' OCCUR
<br />
<br />Clinical Laboratories of
<br />San Bernardino, Inc.
<br />P.O. Box 329
<br />San Bernardino CA 92402
<br />
<br />INSURER D
<br />1-----'---, ,-- ---
<br />INSURER E:
<br />
<br />COVERAGES
<br />
<br />L TR INSR
<br />
<br />A
<br />
<br />I I
<br />l GEN'L AGGREGI\TE LIMIT APPLIES PER II
<br />Ix ! POLICY i j~c?T LOC !
<br />
<br />AUTOMOBILE LIABILITY
<br />
<br />ANY AUTO
<br />
<br />ALL OWNED AUTOS
<br />
<br />SCHEDULED AUTOS
<br />
<br />X HIRED AUTOS
<br />
<br />X , NON.OWNED AUTOS
<br />
<br />BUA2068975084
<br />
<br />02/01/07
<br />
<br />02/01/08
<br />
<br />
<br />GARAGE LIABILITY
<br />ANY AUTO
<br />
<br />A
<br />
<br />EXCESS/UMBRELLA LIABILITY
<br />X OCCUR I l CLAIMS MADE
<br />
<br />CUP20689753444
<br />
<br />02/01/07
<br />
<br />02/01/08
<br />
<br />, DEDUCTIBLE
<br />RETENTION
<br />
<br />
<br />s10,OOO
<br />
<br />B
<br />
<br />WORKERS COMPENSATION AND
<br />EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER F'XCLUDED?
<br />If yes, describe under
<br />SPECIAL PROVISIONS below
<br />OTHER
<br />
<br />C066924302
<br />
<br />02/01/07
<br />
<br />02/01/08
<br />
<br />A
<br />
<br />Property Blanket
<br />
<br />02/01/07
<br />
<br />02/01/08
<br />
<br />CERTIFICATE HOLDER
<br />
<br />CANCELLATION
<br />
<br />NAIC#
<br />20427
<br />I--=----=-
<br />
<br />LIMITS
<br />
<br />: EACH OCCURRENCE
<br />'~DAI\lI)l;GE I U Keo N I eo LJ --
<br />P~MISESLEa occurence)
<br />
<br />~~ED _E,XP (Anyone PersCln)
<br />
<br />PERSONAL & ADV INJURY
<br />---- ---- --- --
<br />GENERAL AGGREGATE
<br />r:RO~UCT~:_C~~~OP~GG
<br />
<br />Emp Ben.
<br />
<br />sl,OOO,OOO
<br />$100,000
<br />s10,OOO
<br />s1,OOO,OOO
<br />1$2,000,000
<br />~----
<br />s Excluded
<br />~---~,._._-
<br />1,000,000
<br />
<br />COMBINED SINGLE LIMIT
<br />(Ea aCCIdent)
<br />
<br />sl, 000, 000
<br />
<br />BODIL Y INJURY
<br />(Per person)
<br />
<br />s
<br />
<br />BODIL Y INJURY
<br />{Per accldenU
<br />
<br />$
<br />
<br />PROPERTY DAMAGE
<br />(Per aCCIdent)
<br />
<br />, $
<br />,
<br />I
<br />
<br />AUTO ONL Y . EA ACCIDENT'S
<br />
<br />EA ACC r-S--
<br />A-GG 1$
<br />,
<br />
<br />OTHER THAN
<br />AUTO ONLY
<br />I EACH OCCURREN~E
<br />r
<br />f AGGREGAT~_
<br />
<br />s5,OOO,OOO
<br />1$-'-.'--
<br />.f-- ----
<br />
<br />i
<br />i
<br />1--
<br />
<br />
<br />~ i TQR'y LIMITS ER
<br />IE L. EACH ACCID.ENT_. __ ~ 000 ! 000
<br />EL.DiSEASE.I=AEMPLOYEE' $ 1, 000, 000
<br />~--- --
<br />" E L. DISEASE. POLICY LIMIT S 1, 000 , 000
<br />
<br />Property
<br />S ecial
<br />
<br />1113000
<br />
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
<br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAlL 30 DAYS WRITTEN
<br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
<br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
<br />REPRESENTATIVES,
<br />AUTHORIZED REPRESENTATIVE
<br />
<br />CITYSAA
<br />
<br />City of Santa Ana
<br />Department Of Public Works
<br />220 S. Daisey Ave.
<br />Santa Ana CA 92703
<br />
<br />~~
<br />
<br />ACORD 25 (2001/08)
<br />
<br />
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