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01/19/2006 11:02 19493056166 COLONIAL PRA PAGE 02/05
<br />A- AI" 0OS l `Ae-/
<br />A -C -ORD, CERTIFICATE OF LIABILITY INSURANCE
<br />oii iz o '
<br />PRDDucRR (800)910-6535 FAX
<br />THIS CERTIFICATE 131SSIfF13 AS A MATTER OF INFORMATION
<br />New Colonial Western
<br />26691 Plaza Drive, Suite 220
<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 />Mission Viejo, CA 9Z691
<br />OENER+L WMDTY
<br />630-08a2C76A
<br />Don Emory
<br />INSURERS AFFORDING COVERAGE
<br />NMC A
<br />INSURED Westcliff Medical Laboratories, Inc.
<br />INsuRERA: St- Paul Travelers
<br />X COMMXRonLCCFIERLL u+lIUTY
<br />1821 E. Dyer Road
<br />INSURER a'
<br />Santa Ana, CA 92705
<br />INSURER C:
<br />CLAIMSMAOE a OCCUR
<br />IN9UPER (-
<br />INSURER E
<br />A
<br />COVERAGFS
<br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVt HUN I Ht r LIUY PERIOD INDICATED, NOTVVITHBTANDING
<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 19 SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH
<br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INS 0 TYPE OF INSURANCE POLICY NUMBER POL YEFFECTNE POLICY E%PIRATIDH LIMIT!
<br />OENER+L WMDTY
<br />630-08a2C76A
<br />10/Q1/2005
<br />10/01/2006
<br />EACH OCCURRENCE 5 1,000,0
<br />X COMMXRonLCCFIERLL u+lIUTY
<br />DAMAGE TO RENTED } T00
<br />CLAIMSMAOE a OCCUR
<br />MEG EXP IAYIV MN Pp ) S 5,000
<br />A
<br />PERSONAL l ADV INJURY f 1,000,000
<br />QC"CNALA CNCDATC L 2,000,006
<br />OE NL AGGREWTE LIMIT APPLIES PER.
<br />PRODUCTS•COMPTOPAGG } 2,000,00(_
<br />7 POUCY JEC LOC
<br />AUTOMOBILE
<br />LIABNJTY
<br />COMBINEOSWGLE LIMB S
<br />ANY AUTO
<br />I£A IHeIMnO
<br />J_
<br />ALL OWNED AUTOS
<br />PnNIIY 1NnIRY T
<br />SCHEDULED AUTOS
<br />IPA, pnnoA)
<br />HIRED AUTOS
<br />BODILY M,1 5
<br />'ION•OWNEp nVTOD
<br />(PM aPAANA0
<br />PROPERTYCAMAGE S
<br />IPA, aCENMLI
<br />GAUGE LIABILITY
<br />AUTO ONLY& EA ACAIDENI a
<br />OTHER THAN 1A ACC S
<br />ANY AUTO
<br />CUP-0892C76A
<br />10/01/2005
<br />AUTO ONLY ADO 5
<br />EXc6331AHBAELLALIABILm
<br />10/01/2006
<br />EACNOCCURRENCE 5 2,000,000
<br />X OCCUR CW
<br />AP RO
<br />I , •, -
<br />1a, �. �1 t
<br />-
<br />>'v
<br />AGGREGATE S 2,000,000
<br />A
<br />LMSMADE
<br />..�i
<br />}
<br />DEDUCTIBLE
<br />/
<br />}
<br />}
<br />RETENTION f
<br />L
<br />WORKER! COMPENSATION AND
<br />-
<br />. c
<br />lliT.l •i, lt.[ ,' _
<br />wf crani, DTH.
<br />TORYLIMn9 __,ER_
<br />EMPLOYERSLIAMUTY
<br />ANY PROPRIETORFARTNERIEXECUTNE
<br />AS::1
<br />'L:ia: l.a! ;l l;,�;
<br />E.L. EACH ACCIDENT S
<br />E.I. DISEASE£A EMPLOYEE 3
<br />OFFWERINEMEER EXCLUDED)
<br />Or,
<br />yaAPaNM1N ISIO
<br />SPECIAL PROYIBIONS ANVA
<br />EL. DISEASE •POLICY LIMIT f
<br />us"ilness
<br />630-08a2C76A
<br />10/01/2005
<br />10/01/2006
<br />Limit; ST,534,B36
<br />A
<br />Personal
<br />roperty Blanket Limit
<br />Dad: 52,500
<br />d DP V.
<br />51,320,000 EDP / Caryuters
<br />JtIDyNOoF O
<br />e nta Ana, T0 T(cEXeCrLUsS,Iemployees,
<br />mpgoyeesD, agents. volunteers,
<br />s, and representatives are named
<br />s additional insureds for General Liability per forms CGDZ4710OZ and CGT3010766 attached.
<br />City of Santa Ana
<br />& Santa Ana Fire Department
<br />Attn: Laura Sheedy
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />ACORD 25 (2001=1 FAX: (714)647-6515
<br />(,)
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED REFORM THE
<br />EXPIRATION DATE THEREOF. THE MRUING INSURER MILL ENDEAVOR TO NAIL
<br />-XL PAPA"ITTCM WT CP TO THP CFPTInCATE HOLDER NAMED TO THE LEFT
<br />MAIL BUON NOTICE SHALL IMPOSB NO OBUGAOON OR W SILKY
<br />IN THE INSUR/ ITB AGENTS OR REPRESENTATIVES.
<br />IDACORO CORPORATION 1968
<br />
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