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<br />Date: 4/112008 !1 13 AM Pag~ ... of 4
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<br />OP 10 N...I OATE (MMlOCllVY'r"Il
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<br />CLINr-i'~ 04/01/00
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<br />THIS CERTIFICATE IS ISSUED AS A MATTER Of INFORMATION
<br />ONLY AND CONf'~"'" NO 'UGHT~ UPON THE CERTIFICATE:
<br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />ALTER THE COVERAGE AFFOR.DED BY TloIE POI.ICIES BELOW. __
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<br />CERTIFICATE OF LIABILITY INSURANCE
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<br />PRODlJriOR
<br />Andreini & Company-south Coast
<br />L1cense 0208825
<br />One ~cArthur Placo, Suite ~OO
<br />South Coa~t Met%o CA 92101
<br />Phone:714-327-1400 Fax:714-321-1499
<br />
<br />Clinical Laboratories of
<br />Snn Bernardino, Inc.
<br />P.O. Box ~2g
<br />San Bernardino CA 92402
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<br />-1-'NSURERS AFFORDING COVERAGE
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<br />02/01/00
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<br />OESCRIPTION OF OPERATiONS I LOCATIONS I VEHI\:LES I EXCLUSIONS ADDEO BY ENooRselli::iIIT iSriECIAL'~ -
<br />**REVISES , REPLACES CERTIFICATE ORIGINALLY ISSUED 02/15/08**
<br />Certificate Holaer is additional insured as respects to General Liabili~y
<br />per written contract per attached G-17957-G99
<br />The CANCELLATION notice herein is ~nde~ to re~d 10 daY8 as ~espects any
<br />cancellation due to non-payment o~ pr~um,
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<br />02/01/08 I
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<br />02/01/09
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<br />Claim!A9Q
<br />Deduct,
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<br />3,000,000
<br />100,000
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<br />CERTIFICATE:: HOLDER
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<br />CANCELLATION
<br />
<br />CITYSAA
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<br />M"OULO ANY UF T~ JlflCVE DESCRIBED POlICIES BE' CANCELLED BE"):ORE THE EXPIRATION
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<br />OAT!:. THEREOF, THEISSUI~Go 'NSURERWllL ENDEAVOR TO MAIL 30
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<br />OAYSWRITIEN
<br />
<br />city of Santa Ana
<br />Department Of Pub11C
<br />220 S. Daisey Ave,
<br />Santa Ana CA 92703
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<br />Works
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<br />NOTICE TO TI1E CERTlFICAlll-<OtDERNAMED TOniE LEFT, BUT FAlLUR€ TOOO 8U SHALL
<br />IMPOSE N('J OBi IGATION OR l1Ml1U1"f OF ANY IUND UPON THE lNSIJREFl, If:> AGENTS OR
<br />REPRF.SENrATNlS,
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